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NARCOTICS  RESEARCH,  REHABILITATION, 

AND  TREATMENT 


HEARINGS 

BEFORE  THE 

SELECT  COMMITTEE  ON  CRIME 
HOUSE  OF  REPRESENTATIVES 

NINETY-SECOND  CONGEESS 

FIRST  SESSION      '"    '" 

PUESUANT   TO 

H.  RES.  115,  A  RESOLUTION  CREATING  A  SELECT  COMMITTEE 
TO  CONDUCT  STUDIES  AND  INVESTIGATIONS  OF 
CRIME  IN  THE  UNITED  STATES 


PART  1  OF  2  PARTS 


APRIL  2Q,  27,  28,  1971 ;  WASHINGTON,  D.C. 


Serial  No.  92-1 


Printed  for  the  use  of  the  Select  Committee  on  Crime 


U.S.  GOVERNMENT  PRINTING  OFFICE 


60-296  WASHINGTON  :   1971 


For  sale  by  the  Superintendent  of  Documents,  U.S.  Government  Printing  Office 
Washington,  D.C,  20402  -  Price  .$1.50 

NORTHEASTERN  UNiVERSin  SCHOQL  of  LAW  IMM 


SELECT  COMMITTEE  ON  CRIME 

CLAUDE  PEPPER,  Florida,  Ghairman 

JEROME  R.   WALDIE,  California  CHARLES  E.  WIGGINS,  California 

FRANK  J.  BRASCO,  New  York  SAM  STEIGER,  Arizona 

JAMES  R.   MANN,   South  Carolina  LARRY  WINN,  Je.,  Kansas 

MORGAN  F.  MURPHY,  Illinois  CHARLES  W.   SANDMAN,  Jr.,  New  Jersey- 

CHARLES  B.  RANGEL,   New  York  WILLIAM  J.  KEATING,  Ohio 

Paul  L.  Perito,  Chief  Counsel 
Michael  W.  Blommer,  Associate  Chief  Counsel 

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CONTENTS 


April  26 1 

April  27 77 

April  28 209 

June  2 341 

June  3 _^____^ 391 

June  4 .-. 481 

June  23 553 

Oral  Statements  by  Government  Witnesses 

Health,  Education,  and  Welfare,  Department  of: 
Food  and  Drug  Administration: 

Edwards,  Dr.  Charles  C,  Commissioner : 393 

Gardner,  Dr.  Elmer  A.,  Consultant  to  the  Director,  Bureau  of 

Drugs ___       393 

Jennings,  Dr.  John,  Associate  Commissioner  for  Medical  Affairs.       393 
Health  Services  and  Mental  Health  Administration: 
National  Institute  of  Mental  Health: 

Besteman,  Dr.  Karst,  Acting  Director,  Division  of  Narcotics 

and  Drug  Abuse 430.  439 

Brown,  Dr.  Bertram,  Director 430,  439 

Martin,    Dr.    William,    Chief,    Addiction    Research    Center, 

Lexington,  Kj' 435,439 

van  Hoek,  Dr.  Robert,  Associate  Administrator  for  Operations.  430,439 
Narcotics  and  Dangerous  Drugs,  Bureau  of: 

IngersoU,  Hon.  John  E.,  Director 344,  439 

Lewis,  Dr.  Edward,  Chief  Medical  Officer 344,  439 

Miller,  Donald  E.,  Chief  Council 344,  439 

Treasury,  Department  of,  Hon.  Eugene  T.  Rossides,  Assistant  Secretary, 

Enforcement  and  Operations 61 

Oral  Statements  by  Public  Witnesses 

AREBA  (Accelerated  Reeducation  of  Emotions,  Behavior,  and  Attitudes), 
Dr.  Daniel  H.  Casriel,  director;  accompanied  by  Rev.  Raymond  Massev 
and  Dr.  Walter  Rosen '_       273 

Brickley,  Hon.  James  H.,  Lieutenant  Governor,   State  of  Michigan   (on 

behalf  of  Gov.  William  G.  Milliken) 614 

Brill,  Dr.  Henry,  director,  Pillgrim  State  (N.Y.)   Hospital 51 

Carter,  Hon.  James,  Governor,  State  of  Georgia 608 

Casriel,   Dr.   Daniel  H.,   director,   AREBA   (Accelerated  Reeducation  of 

Emotions,  Behavior,  and  Attitudes) 273 

Chambers,    Dr.    Carl,    director,    division   of   research,    New    York    State 

Narcotic  Addiction  Control  Commission 558 

Davidson,   Dr.    Gerald  E.,  a.ssociate  director,   Drug  Dependency  Clinic, 

Boston  City  Hospital 322 

Drug  Dependency  Clinic,  Boston  City  Hospital,  Dr.  Gerald  E.  Davidson, 

associate  director ^^ ^ 322 

DuPont,  Dr.  Robert  L.,  Director,  District  of  Columbia  Narcotics  Treat- 
ment Administration 143 

Eddy,  Dr.  Nathan  B.,  Chairman,  Committee  on  Problems  of  Dnig  Depend- 
ence, Division  of  ]\Iedical  Sciences,  National  Academy  of  Sciences- 
National  Research  Council 29 

Gearing,  Dr.  R.  Frances,  associate  professor,  division  of  epidemiology, 
Columbia  University  School  of  Public  Health  and  Administrative 
Medicine 105 

Georgia,  State  of,  Gov.  James  Carter ^ 608 

(ra) 


IV 

Page 

Gollance,  Dr.  Harvey,  associate  director,  Beth  Israel  Medical  Center 239 

Hesse,  Rayburn  F.,  special  assistant  to  the  chairman,  Federal-State  rela- 
tions, New  York  State  Narcotic  Addiction  Control  Commission 5.58 

Holden,  William,  department  head,  MITRE  Corp 80 

Holton,  Hon.  Linwood,  Governor,  Commonwealth  of  Virginia .594 

Horan,  Robert  F.,  Jr.,  Commonwealth  attorney,  Fairfax  County,  Va 255 

Illinois  Drug  Abuse  Program,  Dr.  Jerome  H.  Jaffe,  director 210 

Institute  of  Applied  Biology,  Rev.  Raymond  ^Nlassey 273 

Jaflfe,  David,  department  staff,  MITRE  Corp 80 

Jaflfe,  Dr.  Jerome  H.,  director,  Illinois  Drug  Abuse  Program 210 

Jones,   Howard  A.,   commissioner,   New   York  State  Narcotic  Addiction 

Control  Commission 558 

Kramer,  Dr.  John  C,  assistant  professor,  department  of  psychiatry  and 
human  behavior,  department  of  medical  pharmacology,  University  of 

California  (Irvine) 642 

Kurkmd,  Dr.  Albert  A.,  director,  Maryland  State  Psychiatric  Research 

Center 505 

McCoy,  William  O.,  Maryland  State  Psychiatric  Pi,esearch  Center 506 

Maryland  State  Psychiatric  Research  Center; 

Kurland,  Dr.  Albert  A.,  director 505 

McCoj^,  William ,506 

Taylor,  Robert 507 

Masse}',  Rev.  Raymond,  Institute  of  Applied  Biology 273 

Michigan,  State  of,  Lt.  Gov.  James  H.  Brickley  (on  behalf  of  Gov.  WiUiara 

G.  Milliken) 614 

MITRE  Corp 80 

Holden,  William,  department  head. 
Jaffe,  David,  department  staff. 

Yondorf,  Dr.  Walter,  associate  director,  national  command  and  con- 
trol division. 
Narcotics  Treatment  Administration,  District  of  Columbia,  Dr.  Robert  L. 

DuPont,  Director 143 

New  York  State  Narcotic  Addiction  Control  Commission: 

Chambers,  Dr.  Carl,  director,  division  of  research 558 

Hesse,  Rayburn  F.,  special  assistant  to  the  chairman,  Federal-State 

relations 558 

Jones,  Howard  A.,  commissioner 558 

Pennsylvania,  Commonwealth  of.  Gov.  Milton  Shapp 602 

Resnick,  Dr.  Richard  B.,  associate  professor,  department  of  psychiatry, 

New  York  Medical  College 1 .539 

Rosen,  Dr.  Walter,  New  York,  N.Y 273 

Seevers,  Dr.  Maurice  H.,  chairman,  department  of  pharmacology,  University 

of  Michigan  Medical  School 9 

Shapp,  Hon.  Milton,  Governor,  Commonwealth  of  Pennsylvania 602 

Taylor,  Robert,  Maryland  State  Psychiatric  Research  Center 507 

Villarreal,  Dr.  Julian  E.,  associate  professor  of  pharmacology,  University 

of  Michigan  Medical  School 1 483 

Virginia,  Commonwealth  of,  Gov.  Linwood  Holton 594 

Yondorf,  Dr.  Walter,  associate  director,  national  command  and  control 

division,  MITRE  Corp 80 

Exhibits  Received  for  the  Record 

exhibit  no.  1 

American  Medical  Association,  Dr.  Richard  S.  Wilbur,  deputy  executive 
vice  president,  letter  dated  July  9,  1971,  to  Paul  L.  Perito,  chief  counsel. 
Select  Committee  on  Crime 16 

EXHIBIT    NO.    2 

Seevers,  Dr.  Maurice  H.,  chairman,  department  of  pharmacology,  Univer- 
sity of  Michigan  INIedical  School,  curriculum  vitae 1 22 

EXHIBIT    NO.    3 

Defense,  U.S.  Department  of,  Dr.  Louis  M.  Rousselot,  Assistant  Secre- 
tary, Health  and  Environment,  letter  dated  June  28,  1971,  to  Chairman 
Pepper,  with  attachments _ 24 


V 

EXHIBIT    NO.    4    (a)    AND    (b) 

Eddy,  Dr.  Nathan  B.,  Chairman,  Committee  on  Problems  of  Drug  De- 
pendence, Division  of  Medical  Sciences,  National  Academj^  of  Sciences- 
National  Research  Council:  P»Ke 

(a)  Prepared  statement 40 

(b)  Curriculum  vitae 42 

EXHIBIT  NO.  5  (a)  AND  (b) 

Brill,  Dr.  Henry,  director,  Pilgrim  State  Hospital,  New  York,  N.Y.: 

(a)  Prepared  statement 58 

(b)  Curriculum  vitae 59 

EXHIBIT    NO.    6 

State,  Department  of,  David  M.  Abshire,  Assistant  Secretary  for  Congres- 
sional Relations,  letter  dated  July  2,  1971,  to  Chairman  Pepper,  with 
attachments 70 

EXHIBIT    NO.    7 

Treasur}^  Department  of,  Eugene  T.   Rossides,  Assistant  Secretary  for 

Enforcement  and  Operations,  curriculum  vitae 75 

EXHIBIT    NO.    8    (a)    AND    (b) 

Jaffe,  David,  department  staff,  MITRE  Corp.: 

(a)  Supplemental  statement 101 

(b)  Curriculum  vitae 102 

EXHIBIT    NO.    9 

Ulrich,  William  F.,  manager,  applications  research,  scientific  instruments 
division,  Beckman  Instruments,  Inc.,  prepared  statement  (dated 
June  27,  1970) 103 

EXHIBIT    NO.    10    (a)    AND    (b) 

Gearing,  Dr.  Francis  R.,  associate  professor,  division  of  epidemiology^, 
Columbia  University  School  of  Public  Health  and  Administrative 
Medicine : 

(a)  Paper  entitled  "Successes  and  Failures  in  Methadone  Mainte- 
nance Treatment  of  Heroin  Addiction  in  New  York  City" 121 

(b)  Position  paper  entitled  "Methadone — A  Valid  Treatment  Tech- 
nique"        138 

EXHIBIT    NO.    11    (a)    THROUGH    (e) 

DuPont,  Dr.  Robert  L.,  director.  District  of  Columbia  Narcotics  Treat- 
ment Administration : 

(a)  Article  entitled  "Profile  of  a  Heroin  Addict" 166 

(b)  Study  entitled  "Summary  of  6-Month  Followup  Study" 178 

(c)  Brief  collection  of  statistical  information  entitled  "Dr.  DuPont's 
Numbers 183 

(d)  An  administrative  order  setting  forth  guidelines  for  methadone 
treatment 183 

(e)  Article  entitled  "A  Study  of  Narcotics  Addicted  Offenders  at  the 

D.C.  Jail" '_ 195 

EXHIBIT    NO.    12 

Jaffe,  Dr.  Jerome  H.,  director,  Illinois  Drug  Abuse  Program,  curriculum 

vitae 236 


VI 

EXHIBIT    NO.    13    (a)    THROUGH    (C)' 

Page 
GoUance,  Dr.  Harvey,  associate  director,  Beth  Israel  Medical  Center: 

(a)  Article  entitled  "Methadone  Maintenance  Treatment  Program".  _       249 

(b)  Letter  dated  May  7,  1971,  to  Chris  Nolde,  associate  counsel, 
Select  Committee  on  Crime 253 

(c)  Letter  dated  Nov.  11,  1970,  to  Dr.  Vincent  P.  Dole,  Rockefeller 
University  from  Carlos  Y.  Benavides,  Jr.,  assistant  district 
attorney,  Laredo,  Tex 254 

EXHIBIT    NO.    14    (a)    THROUGH    (g) 

Casriel  Dr.  Daniel  H.,  director,  AREBA  (Accelerated  Reeducation  of 
Emotions,  Behavior,  and  Attitudes) : 

(a)   Article  entitled  "The  Case  Against  Methadone" 296 

(h)   Article   entitled    "Casriel    Institute    of    Group    Dynamics,    New 

York,  N.Y."  (discussion  of  Dr.  Revici  paper  on  Perse) 302 

(c)  Submission  entitled  "Significant  Therapeutic  Benefits  Based  on 

Peer  Treatment  in  the  Casriel  Institute  and  AREBA" 311 

(d)  Introduction  and  explanation  of  the  AREBA  program 314 

(e)  Reprint  of  article  from  the  Medical  Tribune-World  Wide  Report 

entitled  "Therapy  of  Narcotic  Addicts  Sparks  Psychiatric  Theory".  315 

(f)  Article  reprinted  from  the  Sandoz  Panorama  entitled  "The  Family 
Physician  and  the  Narcotics  Addict" 317 

(g)  Curriculum  vitae 320 

EXHIBIT    NO.    15 

Davidson,  Dr.  Gerald  E.,  associate  director,  drug  dependency  clinic, 
Boston  Citv  Hospital,  study  entitled  "Results  of  Preliminary  Perse 
Study"....: 331 

EXHIBIT    NO.    16 

Beaver,  Dr.  William  T.,  associate  professor,  department  of  pharmacology, 
Georgetown  University  School  of  Medicine  and  Dentistry,  prepared 
statement 334 

EXHIBIT    NO.    17    (a)    THROUGH    (e) 

Health,  Education,  and  Welfare,  Department  of: 

(a)  Jennings,  Dr.  John,  Associate  Commissioner  for  Medical  Affairs, 

Food  and  Drug  Administration,  prepared  statement 420 

(b)  Edwards,  Dr.  Charles  C,  Commissioner,  Food  and  Drug  Admin- 

istration, memorandum  dated  May  14,  1971,  with  attachments.       422 

(c)  van  Hoek,  Dr.  Robert,  Associate  Administrator  for  Operations, 

Health  Services  and  Mental  Health  Administration,  prepared 
statement 430 

(d)  Brown,  Dr.  Bertram  S.,  Director,  National  Insititue  of  Mental 

Health,   Health   Services  and   Mental  Health   Administration, 
prepared  statement 469 

(e)  Steinfeld,  Dr.  Jesse  L.,  Surgeon  General,  letter  dated  June  21, 

1971,  to  Chairman  Pepper 480 

EXHIBIT    NO.    18 

Villarreal,  Dr.  Julian  E.,  associate  professor  of  pharmacology.  University 

of  Michigan  Medical  School,  prepared  statement 502 

EXHIBIT    NO.    19 

Agriculture,  Department  Of,  N.  D.  Bayley,  Director  of  Science  and  Educa- 
tion, Office  of  the  Secretary,  letter  dated  July  23,  1971,  to  Chairman 
Pepper,  re  thebaine 510 

EXHIBIT    NO.    20 

Kurland,  Dr.  Albert  A.,  director,  Maryland  State  Psychiatric   Research 

Center,  prepared  statement 520 


vn 

EXHIBIT  NO.  21  (a)   and   (b) 

Page 

New  York  State  Narcotic  Addiction  Control  Commission,  Howard  A.  Jones, 
Chairman-designate : 

(a)  Letter  dated  June  22,    1971,  to  the  committee,  re  summary  of 

New  York  State  drug  report 578 

(b)  Prepared  statement 580 

EXHIBIT    NO.   22 

Holton,  Hon.  Linwood,  Governor,  Commonwealth  of  Virginia,  prepared 

statement 597 

EXHIBIT    NO.    23 

Shapp,  Hon.  Milton,  overnor,  Commonwealth  of  Pennsylvania,  pre- 
pared statement 606 

EXHIBIT    NO.    24 

Carter,  Hon.  James,  Governor,  State  of  Georgia,  prepared  statement 612 

EXHIBIT    NO.    25 

Brickley,  Hon.  James  H.,  Lieutenant  Governor,  State  of  Michigan,  pre- 
pared statement 617 

EXHIBIT    NO.    26    (a)    THROUGH    (f) 

Letters  and  statements  of  officials  of  various  cities  regarding  problems 
of  drug  abuse: 

(a)  Boston,  Mass.,  Mayor  Kevin  A.  White 628 

(b)  Detroit,  Mich.,  Mayor  Roman  S.  Gribbs 630 

(c)  Hartford,  Conn.,  Mayor  George  A.  Athanson 631 

(d)  New  Haven,  Conn.,  Mayor  Bartholomev.'  A.  Guida 634 

(e)  Philadelphia,  Pa.: 

O'Neill,  Joseph  F.,  police  commissioner 637 

Sofer,    Dr.    Leon,    deputy    health    commissioner,    office    of 

mental  health/mental  retardation 638 

(f)  Washington,  D.C.,  Mayor  Walter  E.  Washington 640 

EXHIBIT    NO.    27 

Kramer,  Dr.  John  C,  assistant  professor,  department  of  psychiatry  and 
human  behavior,  department  of  medical  pharmacology,  L^niversity 
of  California  (Irvine),  prepared  statement 662 

EXHIBIT    NO.    28 

Statement  submitted  on  behalf  of  S.  B.  Penick  &  Co.,  Merck  &  Co.,  Inc., 

and  Mallinckrodt  Chemical  Works 670 

EXHIBIT    NO.    29 

Becker,  Arnold,  public  defender,  Rockland  County,  N.Y.,  statement .__       677 

EXHIBIT    NO.    30 

Andrews,  Rev.  Stanley  M.,  Libert}'  Lobby,  prepared  statement 679 

EXHIBIT    NO.    31 

Benson,  Dr.  Richard  S.,  letter  dated  August  4,  1971,  to  Chairman  Pepper, 

re  transcendental  meditation  (with  enclosures) 681 

EXHIBIT    NO.   32 

'Copy  of  letter  sent  to  drug  companies  by  Chairman  Pepper  re  research 

concerning  narcotic  blockage  and  atagonistic  drugs 690 


NARCOTICS  RESEARCH,  REHABILITATION, 
AND  TREATMENT 


monday,  april  26,  1971 

House  of  Representatives, 
Select  Committee  on  Crime, 

Washington^  B.C. 

The  committee  met,  pursuant  to  notice,  at  10 :05  a.m.,  in  room  2359, 
Rayburn  House  Office  Building,  Hon.  Claude  Pepper  (chairman) 
presiding. 

Present:  Representatives  Pepper,  Mann,  Wiggins,  Steiger,  Winn, 
and  Keating. 

Also  present :  Paul  Perito,  chief  counsel ;  and  Michael  W.  Blommer, 
associate  chief  counsel. 

Chairman  Pepper.  The  committee  will  come  to  order,  please. 

The  House  Select  Committee  on  Crime  today  begins  7  days  of 
public  hearings  which  will  cover  four  separate  but  related  areas  of 
narcotic  addiction.  We  have  been  examining  the  complex  problems  of 
drug  abuse  and  drug  dependence  since  our  inception  as  a  committee 
on  crime  in  May  1969.  The  heroin  addiction  crisis  has  reached  threat- 
ening proportions.  Our  cities  are  beseiged.  Our  suburban  areas  have 
become  infected.  Even  our  rural  areas  are  now  feeling  the  shocking 
effect  of  this  malady.  Drug  abuse  and  drug  dependence  have  become 
so  unmanageable  that  they  are  now  responsible,  both  directly  and 
indirectly,  for  contributing  to  50  percent  of  the  street  crime  in  our 
Nation.  While  our  population  has  increased  13  percent  from  1960  to 
1969,  crimes  against  property  increased  151  percent,  and  violent 
predatory  crimes  increased  130  percent. 

In  the  face  of  this  mounting  evidence  of  spiraling  street  crime,  our 
citizens  are  properly  asking  whether  their  Government  is  helpless, 
or  corrupt,  or  even  worse,  totally  incapable  or  unwilling  to  deal  with  a 
public  health  epidemic. 

The  national  heroin  addiction  epidemic  places  an  impossible  burden 
upon  an  overburdened  criminal  justice  system.  This  heroin  epidemic 
forces  our  police  to  allocate  their  resources  unequally  in  attempting  to 
stem  the  illicit  drug  traffic.  Testimony  taken  by  our  committee  in  New 
York,  Washington,  San  Francisco,  Boston,  and  Miami  vividly  dem- 
onstrated the  fact  that  prosecutors  must  devote  an  inordinate  amount 
of  their  time  and  staff  to  the  investigation  and  prosecution  of  cases 
which  are  heroin  connected.  Our  Crime  Committee  investigators  have 
revealed  that  in  New  York,  as  in  most  of  our  major  cities,  the  adminis- 
tration of  criminal  justice  has  been  brought  to  a  virtual  standstill  be- 
cause of  the  volume  of  heroin  related  cases.  Probation  officers  through- 
out the  country  have  advised  our  investigators  that  they  cannot  begin 

(1) 


to  cope  witli  the  burdens  imposed  on  their  officers  b}'  heroin  addiction 
probationers.  For  the  same  reason,  our  prisons  also  are  overloaded  and 
our  detention  facilities  arc  strained  beyond  imagination.  How  can  these 
institutions  be  expected  to  perform  the  pi-oper  function  of  confinement, 
which  is  rehabilitation  ?  Correction  and  rehabilitation  are  not  only  hin- 
dered by  the  heroin  epidemic,  they  are  made  virtually  impossible.  As  a 
direct  result,  our  alleged  correction  process  has  become  a  myth,  and 
recidivism  flourishes  in  every  major  city  in  our  Nation. 

The  cost  in  terms  of  dollars  is  staggering.  The  cost  in  terms  of  lives 
lost  is  appalling.  Truly,  the  heroin  addiction  epidemic  has  become  a 
national  tragedy. 

If  we  attempt  to  compute  the  monetnry  loss  resulting  from  this 
heroin  epidemic,  we  must  include  the  involuntary  social  costs;  that 
is,  the  cost  for  law  enforcement  and  the  administration  of  criminal 
justice,  the  cost  of  production  losses.  Our  statistical  computation  of  the 
national  dollar  loss  due  to  the  heroin  epidemic  ranges  from  $1.5  to  $2 
billion  aniuially.  But  this  staggering  amount  of  lost  dollars  pales  into 
insignificance  when  we  consider  the  loss  of  human  life  related  to  heroin 
addiction.  Dr.  Milton  HelpeT-n,  chief  medical  examiner  of  New  York 
City,  told  our  committee  in  June  that  in  1960  there  were  199  narcotic- 
related  deaths  in  New  York,  but  this  figure  soared  to  1.006  deaths  in 
1969.  Sadly,  of  the  1,006  narcotic-related  deaths  in  1969,  255  were  teen- 
agers. Heroin  addiction  is  the  leading  cause  of  death  in  New  York 
among  adolescents  and  young  adults  between  the  ages  of  15  and  35. 
The  heroin  death  rate  in  New  York  is  not  typical  for  densely  popu- 
lated metropolitan  areas. 

In  Dade  County,  Fla.,  my  congressional  district,  41  young  people 
died  from  heroin  last  year,  and  nine  deaths  have  already  been  re- 
ported as  of  this  year. 

The  death  rate  for  narcotism  in  Washington  and  Miami  have  at- 
tested to  similar  growth  patterns. 

You  may  wonder  why  our  witness  list  today  includes  three  out- 
standing scientists  and  medical  clinicians  but  only  one  law  enforce- 
ment official.  You  may  wonder  why  a  committee  on  crime  is  soliciting 
the  views  of  the  scientific  and  medical  communities  and  not  concen- 
trating exclusively  upon  local  police  officials  and  narcotics  agents. 
You  may  wonder  why  this  committee  is  vitally  concerned  about  the 
insignificant  amount  of  Federal  and  State  dollars  devoted  to  research 
into  the  development  of  more  eflFective  blockage  and  antagonistic 
drugs,  and  synthetic  substitutes  for  heroin  and  morphine. 

It  is  precisely  because  we  have  taken  a  comprehensive  view  of  the 
national  and  international  drug  abuse  and  drug  addiction  problem 
that  we  are  today  examining  the  capabilities  of  our  scientific  and 
medical  communities  to  deal  with  this  national  heroin  epidemic. 

We  have  for  too  long  relied  solely  upon  law  enforcement  to  control 
this  public  health  menace.  This  is  not  to  suggest  that  law  enforcement 
should  not  play  a  vital  role  in  what  should  be  a  national  commitment 


to  stem  the  tide  of  narcotic  addiction  arid  interdict  the  flow  of  illicit 
heroin  into  our  country.  However,  we  can  no  longer  delude  ourselves 
with  the  thought  that  law  enforcement  alone  is  capable  of  controlling 
or  even  substantially  reducing  the  flow  of  illicit  heroin  into  the 
United  States  or  of  reducing  the  number  of  addicts  daily  threatening 
our  cities.  Heroin  addiction  is  clearly  crimogenic.  Information  gath- 
ered by  our  investigators  leads  us  to  conclude  that  a  svibstantial  por- 
tion of  our  addict  population  must  not  only  steal,  but  also  deal^ 
in  order  to  pay  for  their  voracious  habits.  Every  addict  dealer  is  a. 
walking  health  menace. 

Dr.  Robert  DuPont,  of  the  District  of  Columbia  Narcotics  Treat- 
ment Administration,  estimates  that  the  average  addict  in  the  District- 
gets  illegal  possession  of  $50,000  worth  of  goods  a  year  to  sustain  his 
addiction. 

The  mounting  evidence  of  the  growing  illicit  flow  of  heroin  into 
the  United  States  compels  the  conclusion  that  we  must  search  for  new 
and  imaginative  answers.  Our  scientific  and  technological  capabilities 
must  be  enlisted  in  the  fight.  No  longer  will  the  prosaic  law  enforce- 
ment approaches  of  the  past  serve  as  guides  for  future  congressional 
conduct. 

It  is  with  this  prospective  that  we  open  7  days  of  heai'ings  in  which 
we  plan  to  explore  some  brave  new  worlds  in  our  struggle  against  the 
menace  of  a  national  heroin  epidemic. 

In  January,  our  committee  filed  a  heroin  report  with  the  Congress 
in  which  we  recommended  that  our  Government  advocate  and  nego- 
tiate toward  the  total  eradication  of  worldwide  opium  cultivation.  We 
are  convinced  of  the  futility  of  relying  solely  upon  overburdened  and 
devoted  customs  and  narcotics  agents  whom  we  have  assigned  tlu'  im- 
l)0ssible  burden  of  policing  our  borders  and  ferreting  out  heroin  traf- 
fickers. Responsible  law  enforcement  officials  have  told  our  committee 
that  the  combined  efforts  of  our  dedicated  Federal  and  State  narcotic 
agents  result  in  seizures  of  less  than  20  percent  of  the  heroin  smuggled 
into  our  country.  Even  if  we  were  to  double  the  size  of  our  narcotic 
enforcement  agencies  and  provide  them  with  unlimited  spending  au- 
thorization, we  might  be  able  to  increase  our  seizures  100  percent  and 
thereby  seize  40  percent  of  the  heroin  destined  for  the  addicts'  eager 
veins.  But  what  about  the  remaining  60  percent  ?  How  can  we  possibly 
expect  customs  agents  to  search  the  250  million  people  who  pass 
through  our  borders  each  year  ?  How  can  we  possibly  and  reasonably 
expect  the  customs  agents  and  narcotic  officials  to  inspect  the  65.310.- 
807  cars  and  trucks,  the  306,476  planes,  and  the  156,994  ships  wiiich 
entered  our  country  last  year  ? 

We  have  been  told  by  the  customs  and  narcotic  officials  that  on  the 
ordinary  size  ship  arriving  at  the  Port  of  New  York  there  are  30,000 
places  where  heroin  can  be  concealed. 

On  a  local  level,  a  recently  concluded  study  by  the  New  York  State 
Investigations  Commission  revealed  that  in  1970,  officers  of  the  under- 


cover  unit  of  the  narcotic  division  of  the  New  York  City  police  made 
7,266  buys  of  narcotics,  and  made  4,007  arrests  in  connection  therewith. 
In  all  of  these  citywide  arrests  made  in  a  year's  time,  a  total  of  4.97 
pounds  of  highly  adulterated  heroin  was  seized.  The  cash  used  by  the 
New  York  police  to  make  these  purchases  totaled  $91,197.50 — that  is 
over  $1,100  an  ounce  for  highly  diluted  heroin.  Surely  it  cannot  be 
argued  that  these  arrests  and  seizures,  at  a  tremendous  cost  of  man- 
power and  actual  cash  outlay,  are  having  a  significant  impact  in  stem- 
ming the  tide  of  organized  narcotic  trafficking  in  the  city  of  New 
York. 

It  seems  highly  unlikely  that  the  continued  diligent  efforts  of  dedi- 
cated narcotics  agents,  on  all  levels,  will  result  in  a  significant  increase 
in  the  rate  of  heroin  seizures.  It  seems  clear  that  if  the  opium  poppy 
continues  to  be  cultivated  legally  there  will  inevitably  be  illegal  traffick- 
ing in  the  heroin  derived  from  this  poppy. 

Consequently,  our  committee  is  today  examining  the  question  of 
whether  we  really  need  the  opium  poppy.  If  we  can  supply  the  pain- 
killing  and  cough-suppressing  needs  of  our  Nation  by  reliance  upon 
domestically  manufactured  synthetic  substitutes,  then  this  Congress 
should  take  the  lead  today  in  banning  the  importation  of  all  crude 
opium.  It  is  to  this  end  that  we  will  devote  a  portion  of  this  hearing. 

We  will  then  hear  from  law  enforcement  experts  and  scientific  re- 
searchers about  the  possibility  of  policing  such  a  worldwide  ban.  We 
also  want  to  know  whether  our  Federal  law  enforcement  officials 
believe  that  this  bold  step  would  be  helpful  to  them,  not  only  in  stem- 
ming the  illicit  flow  of  heroin  into  the  United  States,  but  also  as  a 
lever  in  bargaining  with  officials  from  opium-producing  countries. 

We  then  plan  to  look  at  the  state  of  development  of  narcotic  block- 
age and  antagonistic  drugs.  Our  interest  is  not  confined  to  methadone, 
which  looks  promising  but  is  also  fraught  with  problems.  Our  inter- 
est is  also  in  assessing  the  potential  of  developing  longer  lasting  block- 
age drugs  such  as  acetylmethadol,  which  is  being  used  experimentally 
by  Dr.  Jerome  H.  Jaffe,  in  Chicago.  We  also  want  to  know  whether  the 
so-called  heroin  antagonists  are,  as  Dr.  Stanley  Yolles  (former  Direc- 
tor of  the  National  Institute  of  Mental  Health)  commented,  the  most 
promising  area  in  narcotics  research.  If  this  is  true,  our  committee 
wants  to  know  why  more  adidcts  are  not  now  being  treated  in  rehabili- 
tation centers  throughout  the  country  with  nonaddicting  cyclazocine 
and  naloxone.  What  are  the  results  of  experiments  with  antagonist 
drugs?  Do  scientists  really  believe  that  these  drugs  offer  a  viable 
alternative  to  methadone  maintenance  and  drug-free  treatment 
modalities? 

Additionally,  as  a  committee  on  crime,  we  must  not  only  be  con- 
cerned with  the  humanitarian  aspect  of  opiate  addiction,  but  also  the 


burden  that  such  addiction  imposes  upon  a  society  threatened  and 
ravaged  by  crime  directly  rebated  to  tliis  addiction.  Is  methadone 
maintenance  an  efficacious  method  of  reducing  crime  perpetrated  by 
addicts  under  treatment?  Does  methadone  maintenance  reduce  the 
illegal  activity  of  addicts  and  provide  a  vehicle  to  move  these  addicts 
back  into  our  society  ?  Is  methadone  maintenance  safe  if  properly 
administered  in  a  comprehensive  rehabilitation  program  ? 

Do  the  deaths  recently  attributed  to  methadone — we  have  had  six 
reported  deaths  in  the  last  few  weeks  here  in  the  District  of  Colimi- 
bia — do  the_  deaths  recently  attributed  to  methadone  mean  that  we 
must  reconsider  the  present  posture  of  methadone  maintenance  or  are 
these  deaths  a  natural  incident  and  to  be  expected  with  the  rise  of 
methadone  treatment  programs?  These  are  just  some  of  the  ques- 
tions which  this  committee  wants  answered  during  the  course  of  these 
hearings. 

"VYe  also  want  to  know  whether  the  guidelines  recently  promulgated 
by  the  Food  and  Drug  Administration  will  serve  as  a  barrier  against 
wrongful,  negligent,  and  unlawful  practices  by  some  physicians  who 
have  dispensed  methadone.  We  want  to  examine  the  critical  question 
of  how  can  methadone,  an  admittedly  dangerous  synthetic  drug,  best 
be  dispensed.  "We  want  to  know  whether  methadone  maintenance 
can  truly  be  an  effective  therapeutic  approach  with  the  proper  and 
costly  support  services. 

Finally,  this  committee  intends  to  survey  and  evaluate  our  present 
Federal  and  State  expenditures  relating  to  opiate  research.  We  want 
to  know  if  new  drugs  are  on  the  horizon.  Certainly  the  scientific  genius 
of  this  country  should  be  implored  and  employed  to  help  solve  this 
national  calamity. 

It  might  well  be  that  at  the  conclusion  of  these  7  days  we  have 
raised  more  questions  than  we  have  answered.  However,  we  can  no 
longer  afford  to  avoid  the  unpleasant  evidence  of  the  geometric 
growth  in  narcotic  addiction.  This  tragedy,  however,  might  well  push 
us  into  a  needed  national  mobilization  of  our  medical  and  scientific 
resources  to  destroy  the  awful  heroin  traffic  and  to  deal  humanely 
with  those  who  suffer  from  it.  I  know  I  sjDeak  for  all  the  members  of 
this  committee  when  I  conclude  by  stating  that  this  committee  is 
ready  to  make  the  sacrifice,  financial  and  otherwise,  which  is  neces- 
sary to  wipe  out  this  national  health  epidemic. 

At  this  time,  let  us  place  in  the  record  a  copy  of  House  Resolution 
115,  introduced  January  3,  1971,  and  approved  March  9,  1971,  which 
created  the  Select  Committee  on  Crime  in  the  House  of  Representa- 
tives, described  its  purposes,  set  its  goals,  laid  its  jurisdictions,  and 
delineated  its  functions. 

(H.  Res.  115  follows:) 


6 


92D  CONGKES.S 
1st  J>kssion 


H.  RES.  1 1 5 


IN  TIIK  IIOISK  OF   llKriiKSFXTATLVKS 

.I.\.\i  m;v  -J-I.  1!)71 

.Me.  I'l  rrii;  ( I'of  liiiiist'lf  iind  .Mr.  A\'i(;(:in>)  siil)inittc(l  tin-  r()ll()\vin<r  I'esohition  ; 
wliii-li  wiis  ivIVri'i'd  to  tin'  ("oiumittfe  on  Knlcs 

Fi:ni!r\i;v  l*.">.  I'.'T! 

]>r|)()ilc(l  uilli  ;iiii(Mi(liiiciits,  ivI'eiTi'd  to  tlic  House  Ciilciidar,  ami  ofdorcd  to 

1)0  i)rir>t('d 

.Mmmii   !).  11)71 
( 'oiisidiTi'il,  ;nii(Midi'd,  and  ajifced  lo 


RESOLUTION 

;i  liesolred,    That,    effective   Jamiarv   o,    1971,    there   is 

2  hereby  created  a  select  coiimiittee  to  he  composed  of  eleven 

3  Memher.s  of  the  House  of  Kcpreseiitative.s  to  ))e  appointed 

4  \>\  \\\('  S])eaker,  one  of  \\ii(nii  he  shall  desijiiiate  as  chainnaii. 

5  Any   vacancy   occnrrinji'  in   the   niciuliersliip   of   the   select 
G  coiiiniitlee  shall  he  liHed  in  the  same  manner  in  wjiich  the 

7  oriuinal  ai)pointment  was.  made. 

8  )Six\  2.  The  select  connnittee  is  authorized  and  directed  to 
0  conduct  a  full  and  complete  investigation  ;uid  study  of  all 

10  aspects  of  crime  affecting-  the  United  States,  including,  but 

11  not  limited  to,  (1)  its  elements,  causes,  and  extent ;  (2)  the 

12  preparation,   collection,  and  dissemination  of  statistics  and 


1  (lata;    (->)    the  sliariiis"  oF  iiiloniiatioii.   staiti^itics,  and  data 

2  amoiio'  law  enforcement  awncies,  Federal.  State,  and  local. 

3  inchuling'  the  excliange  of  infoi-niation.  .statistics,  and  data, 

4  with  foreign  nations;  (4)  the  adeqna(-y  i»l'  law  enforcement 
^  and  the  administration  of  justice,  inchuling'  constitutional  is- 
^  sues  and  prohlems  pertaining  thereto:  (."))  the  effect  of  crime 
'^  and  distnrhanccs  in  the  metro]iolifan  nrhan  areas:  ((>)  the 
^  effect,  directly  or  indirectly,  of  crime  on  the  connnerce  of 
^  the  Nation:    (7)   the  treatment  and  rchahilitation  of  ])ersons 

^^  conxicted  of  crimes;   (8)   mcasni-es  relating  to  the  reduction.. 

^^  control,  or  prevention  of  crime:   (11)   measures  relating  to  the 

^-  injpi'oxement  of    (A)    investigation  and  detection  of  crime, 

^'^  (B)    law  enforcement  techniques,  including,  hut  not  limited 

•^  to.  increased  cooperation  among  the  law  enforcement  agen- 

-^■^'  cies,  and    (C)    the  efTcctive  adnnnistration  of  justice:  and 

^^  (10)   ineasures  and  progi'ams  h>r  increased  respect  for  the 

'  ]n\y  and  constituted  authoi'ity. 

•"^  Si'.C.  .'5.  I'or  till',  pui'posc  of  making  such  in\estigations 
and  studies,  the.  conmiillee  or  any  suhcoimnittee  thereof  is 

a,uthori/ed  to  sit  and  act.  suljject  to  clause  31  of  rule  XI  of 

21  •  •  • 

the  Rules  of  tlie  House  of  Kepresentativcs.  during  the  pres- 

00  .  ... 

ent  Congress  at  such  times  and  places  within  the  United 

23      1  •  • 

States,  includmg  any  Commonwealth  or  possession  thereof, 

24 

wliether  the  House   is   meeting,   has   recessed,   or  has  ad- 

95 

journed,  and  to  hold  such  hearings  and  reipure,  h\'  suhpena 


8 

3 

1  or  odierwise,  tlu'  aUciKljiiicc  and  tcstiiiioii}-  of  ^iicli  \vitiicsscs 

12  and  tlio  ])r()dut'ti()n  of  such  Ixxtks.  records,  correspondence, 

3  menioiaiidiims,  })ai)('rs,  and  documents,  as  it  deems  iieces- 

4  'ijary.  Snbpenas  may  l)c  issued  over  the  signature  of  the  chair- 

5  man  of  the  connnittee  or  any  member  designated  b\'  him  and 
^  may  be  served  liy  any  person  designated  by  such  chainnan 

7  or  member. 

8  Sec.  4.  The  select  connnittee  shall  report  to  the  House  as 

9  .sooii  as  lU'acticable  during  the  present  Congress  the  results 

10  of  its  investigations,  hearings,  and  studies,  together  with  such 

11  recommendations  as  it  deems  advisable.  Any  such  report  or 

12  reports  which  are  made  when  the  House  is  not  in  session 

13  shall  be  filed  \\ith  the  Clerk  of  the  House. 


9 

Chairman  Pepper.  The  committee  is  very  much  pleased  to  call  at 
this  time  Dr.  Maurice  H.  Seevers,  one  of  the  Nation's  most  respected 
researchers  in  the  held  of  driio-  abuse  and  drug  addiction. 

Dr.  Seevers  holds  both  a  Ph.  D.  in  pharmacology  and  an  M.D.  from 
the  University  of  Chicago. 

In  the  course  of  his  distinguished  career,  Dr.  Seevers  has  served  as  a 
research  fellow  in  pharmacology  at  the  Universit}-  of  Chicago ;  an 
instructor  in  pharmacology  at  Loyola  of  Chicago ;  associate  professor 
of  pharmacology  at  the  University  of  Wisconsin;  and  as  associate 
dean  of  the  University  of  Michigan  Medical  School.  Since  1042,  he 
has  served  as  professor  of  pharmacology  and  chairman  of  the  depart- 
ment of  pharmacology  at  the  University  of  Michigan  IMedical  School. 

Dr.  Seevers  is  a  past  president  of  the  American  Society  of  Pharma- 
cology and  Experimental  Therapeutics,  and  has  served  as  chairman 
of  the  executive  committee  of  the  Federation  of  American  Societies 
of  Experimental  Biology. 

He  is  a  consultant  to  the  National  Research  Council's  Committee 
on  Problems  of  Drug  Dependence ;  a  member  of  the  American  Medical 
Association's  Committee  on  Alcoholism  and  Drug  Dependence:  and 
chairman  of  the  American  Medical  Association's  Committee  on  Re- 
search on  Tobacco  and  Health. 

Dr.  Seevers  has  served  as  a  member  of  the  board  of  scientific  coun- 
selors of  the  National  Heart  Institute ;  the  Drug  Abuse  Panel  of  the 
President's  Advisory  Committee,  "Wliite  House  Conference  on  Nar- 
cotics and  Drug  AlDuse;  and  the  Surgeon  General's  Committee  on 
Smoking  and  Health. 

Dr.  Seevers  presently  serves  as  the  American  coordinator  of  the 
United  States- Japan  Cooperative  Program  on  Drug  Abuse;  he  is  a 
member  of  the  Expert  Advisory  Panel  on  Drugs  Liable  To  Produce 
Addiction  of  the  U.N.'s  World  Health  Organization;  and  is  a  con- 
sultant to  the  Minister  of  Health  and  Welfare  of  Japan.  Dr.  Seevers 
was  recently  appointed  by  President  Nixon  to  the  President's  Com- 
mission on  Marihuana  and  Drug  Abuse. 

He  has  served  on  the  editorial  boards  of  numerous  scientific  journals 
and  has  received  honors  befitting  a  man  of  his  wisdom  and  dedication, 
including  three  honors  from  the  Government  of  Japan. 

Dr.  Seevers,  we  are  indeed  honored  to  have  you  here  today,  and  very 
grateful  to  you  for  coming  here. 

Mr.  Perito,  our  chief  coimsel.  You  may  inquire. 

Mr.  PERrro.  Thank  you,  Mr.  Chairman.  Dr.  Seevers,  I  understand 
that  you  have  a  prepared  statement. 

STATEMENT  OF  DE.  MAURICE  H.  SEEVERS,  CHAIRMAN,  DEPART- 
MENT OF  PHARMACOLOGY,  UNIVERSITY  OF  MICHIGAN  MEDICAL 
SCHOOL 

Dr.  Seevers.  I  do. 

Mr.  Perito.  Would  you  care  to  read  that  statement  ? 

Dr.  Seevers.  Thank  you,  sir. 

I  will  address  myself  primarily  to  the  question  of  whether  it  is  pos- 
sible to  substitute  synthetic  drugs  for  horticulturally  derived 
substances. 

60-296— 71— pt.  1 2 


10 

The  question  currently  before  your  committee,  the  substitution  of 
synthetic  narcotic  analgesics  for  narcotic  analgesics  or  their  semisyn- 
thetic derivatives  derived  from  opium  is  not  a  new  one.  Nor  has  it  re- 
mained unanswered  by  competent  authorities  in  the  past.  In  1951,  the 
Committee  on  Drug  Addiction  and  Narcotics — now  the  Committee  on 
Problems  of  Drug  Dependence — National  Academy  of  Sciences-Na- 
tional Research  Council,  was  confronted  by  the  following  questions 
by  the  Munitions  Board  (Minutes  of  the  seventh  meeting,  January  15, 
1951,  "Bulletin  of  the  Committee  on  Drug  Addiction  and  Narcotics")  : 

1.  What  percentage  of  national  requirements  for  opium  derivatives  could 
safely  be  replaced  by  synthetics  ? 

2.  If  at  some  stage  during  a  national  emergency  our  stocks  of  opium  should 
become  exhausted  and  irreplenishable,  how  serious  would  be  the  consequences 
on  <he  public  health  in  view  of  the  availability  of  synthetic  substitutes? 

The  Committee  answered  thus — this  was  in  1951,  20  years  ago: 

All  uses  of  morphine,  codeine,  and  other  products  and  compounds  derived  from 
opium  for  systematic  relief  may  be  replaced  adequately  with  substitutes  now 
known.  The  only  question  for  which  a  complete  answer  cannot  be  given  at  pres- 
ent is  whether  or  not  replacement  of  codeine  for  self-medication  for  cough  re- 
lief with  synthetic  agents  would  be  as  safe  as  the  use  of  codeine  itself?  An  im- 
mediate and  intensive  effort  should  be  directed  toward  the  answer  to  this  ques- 
tion of  safety. 

For  several  years  prior  to  this  response  the  Committee  was  be- 
sieged with  requests  to  test  new  synthetic  analgesics  for  their  depend- 
ence liability  on  voluntary  ex-addicts  at  the  USPHS  Hospital  at  Lex- 
ington. This  facility  was  then,  and  still  is,  the  only  place  in  the  world 
where  such  studies  can  be  conducted  on  man. 

The  industrial  output  has  always  been  far  in  excess  of  the  capacity 
of  tliis  clinical  unit. 

Having  utilized  the  rhesus  monkey  as  a  laboratory  model  of  mor- 
phine dependence  since  my  graduate  student  days  in  1925,  and  found 
this  species  remarkably  similar  to  man  in  its  response  to  this  class  of 
drugs,  I  suggested  to  the  committee  that  this  animal  might  be  utilized 
as  a  preliminary  screen  to  reduce  the  number  of  drugs  to  be  tested  in 
man.  After  3  years  of  development  during  which  the  results  on  mon- 
keys were  compared  carefully  with  those  obtained  on  humans  at  the 
Lexington  facility,  satisfactory  testing  procedures  were  available. 
Since  that  time,  this  monkey  colony  at  the  University  of  Michigan  has 
become  a  world  facility.  Over  800  drugs  of  this  class  have  been  evalu- 
ated, representing  the  world  output,  including  all  of  these  Avhich  have 
reached  the  market.  Some  possess  properties  superior  to  those  of  mor- 
phine. Dozens  of  those  tested,  although  not  profitable  for  marketing 
at  the  present  stage,  could  be  used  safely  and  effectively  in  man. 

Tlius  20  years  after  the  limited  affirmative  of  the  NRC  Committee 
the  scientific  answer  today  is  an  unqualified  affirmative. 

But  other  questions  which  relate  to  the  practical  a]:)plication  of  this 
scientific  affirmative  cannot  be  answered  with  such  precision  and  as- 
surance. Whereas  I  make  no  claim  to  expertise  in  all  of  these  areas,  I 
have  been  involved  on  the  scene  over  the  last  30  3'ears,  and  sor.ie  com- 
ments may  be  pertinent.  The  elementary  question,  of  course,  is  two- 
pronged.      ,.,j(,, 

One  aspect  is,  would  the  total  elimination  of  quota  production  by 
U.N.-recognizcd  producing  countries  prevent  the  smuggling  of  non- 


11 

quota  production  from  unrecognized  countries?  The  second  aspect, 
would  it  be  possible  to  control  illicit  production  or  snuiggling  of  syn- 
thetics when  it  is  currently  impossible  to  control  heroin  ? 

The  answer  to  these  two  questions  is  clearly  in  thenegative  without 
international  cooperation,  a  most  uncertain  probability  in  view  of  the 
strong  economic  factors  involved.  May  I  remind  you  that  the  10th 
:session  of  the  Economic  and  Social  Council  of  the  United  Nations  in 
1956  came  within  one  vote  of  adopting  a  resolution  which  would  have 
prohibited  the  production  of  synthetic  narcotics.  This  action  was  of 
such  great  concern  to  Commissioner  Anslinger  that  he  asked  me  to 
write  a  paper  on  the  subject.  This  paper  was  entitled  "Medical  Per- 
spectives on  International  Control  of  Synthetic  Narcotics."  This  arti- 
cle raised  the  ire  of  representatives  of  the  producing  and  manufactur- 
ing nations,  especially  France,  Turkey,  Yugoslavia,  and  India.  They 
objected  to  many  of  the  statements  made  in  this  article  and  for  many 
reasons  but  especially  the  following : 

On  the  contrary,  the  scientific  and  medical  advances  in  the  synthetic  and  nar- 
cotic field  have  been  so  rapid  that  even  today  very  few  natural  products  are  in- 
dispensable to  the  public  health.  The  evidence  in  favor  of  the  "synthetics"  is  so 
impressive  when  subjected  to  comparative  analysis  that  the  author  is  tempted 
to  predict  that  the  day  is  not  far  distant  when  the  Commission  will  be  confronted 
with  resolutions  which  would  propose  to  abolish  forever  the  cultivation  and 
production  of  all  "horticulturally  derived"  narcotics. 

Probably  you  have  heard  the  following  statistics  but  to  refresh  your 
minds:  163  tons  of  morphine  were  manufactured  legally  in  1969.  Ap- 
proximately 90  percent  of  this  was  converted  into  codeine.  Codeine, 
although  present  naturally  in  opium,  is  present  in  such  small  amounts 
that  it  is  not  commercially  practical  to  obtain  codeine  without  convert- 
ing it  from  morphine. 

This  quantity  of  morphine  was  produced  from  1,219  tons  of  opium 
production  and  28.274  tons  of  poppy  straw.  This  was  the  licit  produc- 
tion of  opium.  It  is  controlled  by  the  International  Control  Board 
of  the  United  Nations.  Almost  three-fourths  of  the  total,  864  tons,  was 
produced  by  India.  The  second  largest  producer  was  the  U.S.S.R.,  217 
tons ;  the  third  largest,  Turkey,  with  a  production  of  117  tons,  less  than 
one-tenth  of  the  total.  The  combined  production  of  Iran,  Pakistan, 
Japan,  and  Yugoslavia  was  only  16.7  tons.  If  the  assumption  is  correct, 
that  most  of  the  smuggled  heroin  which  comes  into  the  United  States 
is  derived  from  licit  opium  production,  then  it  is  clear  that  licit  pro- 
duction greatly  exceeds  legitimate  medical  needs. 

The  1970  report  of  the  International  Narcotics  Control  Board  of  the 
United  Nations  which  furnished  the  above  figures  also  contained  the 
following  statement : 

Yet  if  leakages  from  licit  production  could  be  virtually  extinguished,  smugglers 
would  still  be  able  to  have  recourse  to  opium  which  is  produced  illegally  or  be- 
yond Government  control.  There  are  now  extensive  areas  of  such  production 
and  it  is  essential  that,  side  by  side  with  reinforcing  monopoly  controls  over 
licit  production,  major  efforts  should  be  made  to  eliminate  poppy  cultivation  in 
these  areas.  The  regions  chiefly  involved  are  situated  in  Afghanistan,  Burma, 
Laos,  and  Thailand ;  and  there  is  also  some  production  in  parts  of  Latin 
America. 

Other  questions  must  be  dealt  with.  In  my  opinion,  placing  restric- 
tions on  natural  narcotic  analgesics  would  inspire  massive  resistance 
by  organized  medicine  and  the  allied  professions.  Having  served  on 


12 

a  variety  of  committees  of  the  American  Medical  Association  dealing 
with  druss  for  over  20  vears,  I  am  fully  aware  that  physicians  are 
extremely  conservative  about  drug  therapy.  Codeine,  for  example, 
ranks  high  on  the  list  of  "most  prescribed"  drugs  for  the  relief  ot 
cough  and  minor  pains.  It  is  a  constituent  of  many  mixtures  which 
are  "prescribed  for  a  varietv  of  sedative  and  antispasmodic  effects. 

Whereas  we  do  have  effective  substitutes  for  codeine  which  are 
known  to  be  safe,  they  have  made  relatively  little  inroads  in  the  pre- 
scribing of  codine.  Furthermore,  they  do  not  substitute  for  codeine  in 
all  respects,  particularly  since  they  lack  its  analgesic  and  mild  sedative 
properties.  Relative  costs,  although  not  a  compelling  factor,  must  be 
considered.  Tax-free  morphine  is  now  one  of  the  cheapest  compounds 
available  to  medicine  today. 

The  paramount  question  then  which  confronts  you,  in  my  opinion. 
is  not  whether  synthetics  will  substitute  for  "horticulturally  derived" 
narcotics  but  rather  whether  outlawing  the  latter  in  favor  of  synthetics 
will  accomplish  the  objectives  of  significantly  diminishing  abuse  of 
all  narcotic  analgesics  or,  in  fact,  of  even  heroin  itself. 

I  say  this  because  of  several  international  situations.  I  just  returned 
from  Japan  last  week  where  I  consulted  with  the  Minister  of  Health. 
They  know  exactly  how  most  of  the  heroin  and  opium  arrive  in  Japan, 
largely  down  the  Mekong  River  from  the  countries  which  I  mentioned 
earlier,  transshipped  through  Macao  in  Hong  Kong.  From  there  it 
is  smuggled  into  their  many  ports,  some  by  air,  but  mostly  by  sea  to 
Kobe  and  Yokohama,  et  cetera. 

The  Japanese  have  done  a  good  job  of  heroin  control.  In  1964,  the 
Japanese  had  a  sharp  rise  in  heroin  abuse.  They  make  an  all-out  effort 
to  control  this.  They  have  available  to  them  the  facilities  which  I 
doubt  are  available  in  the  United  States.  In  the  first  place,  when  they 
say  an  all-out  Government  effort  they  really  mean  it.  This  goes  from 
the  Prime  Minister  on  down.  In  the  last  4  or  5  years  they  have  helcl 
several  thousand  public  meetings  all  over  Japan  in  which  governors, 
states,  mayors,  even  the  Prime  Minister  participate.  These  are  usually 
held  in  theaters  or  a  public  auditorium  and  may  be  attended  by  as 
many  as  3,000  or  4,000  people.  The  hazards  of  drug  addiction  are 
graphically  portrayed. 

Furthermore,  radio,  television,  newspapers,  and  other  communica- 
tion media  have  made  an  all-out  campaign  against  heroin. 

One  of  the  things  which  I  believe  contributes  significantly  to  their 
success  is  the  fact  that  Japan  has  attacked  one  drug  at  a  time  rather 
than  to  try  to  hit  the  whole  area  of  drug  abuse.  This  goes  back  to  1955 
when  they  had  the  world's  largest  epidemic  of  stimulant  drug  abuse. 
In  that  year  there  were  55,000  arrests  of  methamphetamine  abusers. 
Two  years  later  they  had  reduced  this  by  strong  countermeasures  to  a 
level  of  about  a  thousand  arrests.  This  is  the  only  extensive  epidemic 
of  drug  abuse,  with  which  I  am  familiar,  in  the  world  that  has  been 
controlled  in  such  a  short  time.  They  later  did  a  similar  job  of  con- 
trolling heroin. 

One  of  the  situations  involves  different  attitudes  toward  authority. 
In  Japan,  when  an  expert  goes  on  television,  such  as  a  professor  in 'a 
major  university,  people  listen  to  him.  I  am  certain  this  rarely  occurs 


13 

in  this  country.  This  raises  the  question  whether  we  really  have  the 
capabilities  of  adopting  successfully  this  type  of  approach. 

But  the  Japanese  have  their  problems  as  well.  I  bring  this  in  inci- 
dentally because  it  doesn't  bear  on  your  major  thrust  but  it  is  a  drug 
abuse  problem  which  must  be  dealt  with. 

Last  year,  Japan  had  40,000  arrests  for  glue  sniffing,  with  200  deaths. 
That  is  one  kind  of  substance  which  is  almost  impossible  to  control. 
To  do  so,  we  would  have  to  control  all  sales  from  paint  stores  and  pur- 
veyors of  more  than  50  related  solvents.  Lacquer  thinner  is  used  exten- 
sively in  Japan  by  teenagers  16,  18  years  old.  So  Japan  is  not  without 
her  problems,  but  they  have  done  a  remarkably  good  job  in  controlling 
amphetamines  and  heroin  addiction.  I  was  told  by  the  Ministry  that  it 
liacl  been  reduced  to  a  level  where  they  though  it  was  probably  impossi- 
ble to  reduce  it  further.  I  think  this  is  important — to  recognize  that 
control  will  never  be  absolute. 

Chairman  Pepper.  Mr.  Perito,  any  questions  ? 

Mr.  Perito,  Dr.  See  vers,  I  had  the  opportunity  to  look  at  your  lab- 
orator3^  The  committee  has  not  had  that  unique  opportunity. 

I  wonder  if  you  could  kindly  explain  to  the  committee  exactly  what 
is  being  done  in  your  primate  laboratory  and  how  that  laboratory  is 
financed  ? 

Dr.  Seevers.  This  laboratory  has  been  in  operation  for  20  years.  As 
I  indicated — we  have  tested  during  this  time  some  800  drugs.  This  test- 
ing procedure  started  about  1953.  We  set  it  up  originally  on  an  entirely 
objective  basis  and  it  has  always  remained  so.  Dr.  Nathan  Eddy,  who 
is  here  in  the  room,  has  been  a  long  time  collaborator  on  the  project.  He 
received  these  drugs  on  a  confidential  basis  from  industry.  This  facil- 
ity has  been  available  to  those  who  wish  to  submit  for  testing.  Dr.  Eddy 
sent  them  to  our  laboratory  by  code  number  so  that  we  do  not  know 
the  identity  of  the  supplier. 

Once  the  tests  have  been  made  the  information  is  channeled  back 
to  Dr.  Eddy  and  he  informs  the  manufacturer. 

Until  about  5  years  ago,  our  testing  procedure  involved  primarily 
drugs  which  would  substitute  for  morphine  or  for  heroin.  In  other 
words,  we  were  looking  for  a  drug  which  was  superior  to  morphine 
in  the  sense  it  reduced  respiratory  depression,  less  side  effects,  less  tol- 
erance development,  and  less  what  we  call,  in  general  terms,  addiction 
liability,  the  capacity  to  produce  physical  dependence. 

We  tested  many  compounds  for  15  years  and  didn't  find  any  that 
would  fulfill  most  of  these  qualifications.  Wlien  it  was  discovered  that 
some  of  the  antagonists,  which  I  understand  you  are  going  to  consider 
later,  also  possessed  pain-relieving  properties,  somewhat  like  mor- 
phine, and  yet  did  not  produce  physical  dependence  or  lead  to  addic- 
tion, then  a  new  concept  was  born.  Since  that  time  we  have  tested  a 
hundred  or  more  antagonists.  We  have  done  this  with  the  objective  of 
finding  a  substance  which  would  still  be  useful  as  a  pain  reliever  but 
did  not  have  a  capacity  to  produce  physical  dependence.  I  understand 
that  is  a  class  of  drug  that  you  intend  to  explore. 

We  maintain  a  colony  of  around  a  hundred  monkeys.  They  receive 
an  injection  of  morphine  every  6  hours,  day  and  night,  right  around 
the  clock,  7  days  a  week.  When  we  want  to  test  a  new  drug  we  simply 
substitute  for  the  morphine  which  they  ordinarily  receive.  If  this  drug 


14 

suppresses  signs  of  abstinence  we  then  can  qiiantitate  this  in  a  rough 
way  and  say  this  drug  has  morphine-like  properties.  This  has  been  a 
A^^ery  useful  test. 

The  number  of  drugs  that  have  gone  to  Lexington  during  this 
period  for  test — and  they  were  sent  only  to  Lexington  if  they  possessed 
some  special  propeities  that  were  superior  to  morphine — I  would 
guess,  maybe,  is  in  the  order  of  40.  I  am  not  certain  about  the  exact 
number.  The  facility  at  Lexington  has  never  had  the  capacity  to  test 
more  than  six  or  eight  drugs  in  a  year. 

The  ultimate  test,  of  course,  is  whether  the  effect  in  man  is  desirable 
or  undesirable.  Monkeys  are  not  men,  but  close  enough  to  it  that  it  has 
been  a  very  useful  screen.  We  hope  to  continue  it. 

I  feel  certain  that  the  direction  which  the  research  is  taking  today, 
moving  to  find  a  compound  of  antagonist  type,  ultimately  will  be  suc- 
cessful. We  have  some  good  compounds  now.  Unfortunately,  they  are 
too  short  acting  and  have  to  be  administered  too  often  to  fulfill  the 
practical  requirements  as  substitutes. 

This  class  of  drugs,  incidentally,  acts  entirely  opposite  to  metha- 
done. ]\Iethadone  simply  suppresses  and  acts  like  heroin.  These  new 
drugs  antagonize  heroin  and  create  a  situation  so  that  an  individual 
taking  the  antagonist  can  take  the  heroin  without  anv  effect  on  him. 
In  fact,  in  proper  amounts,  it  completely  wipes  out  any  effects  of 
heroin.  In  the  long  run,  this  is  an  area  where  money  could  be  well 
spent.  I  think  it  is  possible  to  find  techniques  to  make  available  for 
practical  use,  substances  that  we  currently  have  available. 

Many  other  antagonists  have  been  screened  in  our  laborator}^  which 
are  potential  candidates  for  this  type  of  action.  But  they  have  been 
of  no  particular  interest  to  the  manufacturers,  so  they  were  just 
dropped  after  testing.  But  a  careful  review  of  all  antagonists  that  have 
been  studied  in  the  laboratory  might  uncover  some  longer  acting  com- 
pounds that  might  be  useful. 

Dr.  Eddy,  I  run  sure,  will  speak  to  this  point,  because  he  has  been 
the  one  that  has  channeled  the  compounds  to  our  department  and  can 
look  at  the  problem  with  perspective. 

Chairman  Pepper.  Doctor,  you  do  think  it  is  within  the  realm  of 
feasibility  to  develop  an  antagonistic  drug  which  for  all  practical 
purposes  immunizes  the  addict  against  the  euphoria  th.at  he  ordinarily 
gets  from  taking  heroin  ? 

Dr.  Seevers.  I  think  so.  Of  course,  one  problem  that  you  must  recog- 
nize—a practical  problem — is  whether  it  is  possible  to  take  heroin 
addicts  and  force  them  to  take  this  drug.  This  is  analogous  to  the 
methadone  situation.  I  don't  believe  you  will  ever  get  beyond  the 
vohmteer  situation  where  the  addict  says  "I  want  to  get  rehabilitated 
and  will  take  the  drug  voluntarily."  I  suppose  theoretically  it  would  be 
possible  to  force  any  addict  to  take  the  drug.  I  have  doubts  whether 
it  could  be  done  from  the  enforcement  point  of  view. 

Mr.  Perito.  Dr.  Seevers,  could  you  explain  how  your  laboratory  is 
financed  ? 

Dr.  Seevers.  W^ll,  up  until  recently  the  National  Research  Council 
Committee  of  the  Problems  of  Drug  Dependence  had  collected  money 
from  a  wide  variety  of  industrial  groups.  This  is,  I  believe,  the  only 
granting  agency  in  the  National  Eesearch  Council.  They  have  col- 
lected this  money  and  have  used  it  to  support  our  laboratory  and  also- 


15 

from  other  clinical  projects  of  which  Dr.  Eddy  has  been  largely  re- 
sponsible. He  can  outline  this  better  than  I. 

What  is  going  to  happen  in  the  future  I  am  not  certain.  I  believe 
the  Bureau  of  Narcotics  and  Dangerous  Drugs  is  going  to  support 
the  laboratory  because  they  need  this  kind  of  information.  But  this 
has  not  been  completely  clarified  as  yet. 

I  will  retire  this  year.  A^^iether  my  successor,  not  yet  appointed, 
is  amenable  to  carrying  on  this  program  at  Michigan  is  not  yet  known. 
But  I  am  assuming  that  he  is,  because  it  is  a  well  established  and 
on-going  program.  Dr.  Julian  Villarreal,  currently  in  charge  of  the 
program,  I  understand,  will  testify  before  your  group.  He  is  fully 
capable  of  taking  over  this  program  and  has  done  a  beautiful  job  in 
the  last  several  years. 

Mr.  Pekito.  Doctor,  would  it  be  possible  for  your  laboratory  to 
develop  an  eflecti^'e  synthetic  analgesic  which  does  not  have  addiction 
liability  ^ 

Dr.  Seevers.  Well,  none  of  these  antagonists  have  significant  ad- 
diction liability.  This  is  their  advantage,  of  course.  They  do  not  evoke 
the  cellular  changes  in  the  brain  which  is  responsible  for  the  phenom- 
ena of  physical  dependence.  We  have  compounds  at  the  present  time 
that  can  be  administered  chronically  and  they  do  not  produce  physi- 
cal dependence. 

I  am  not  quite  sanguine  enough  to  say  that  we  could  develop  a  eom- 
pound  that,  if  it  has  any  subjective  effects,  would  not  be  abused  by 
some  persons.  We  have  on  the  market  a  substance  of  this  type  now 
which  does  not  produce  significant  physical  dependence:  pentazocine. 
I'his  compound  has  shown  some  small  abuse.  The  number  of  people  who 
will  abuse  this  drug  which  does  not  produce  subjective  effects  is  very 
small.  I  think  if  we  can  reduce  abuse  to  a  minimal  level,  it  is  probably 
the  best  we  can  ever  expect  to  do. 

Chairman  Pepper.  Have  you  had  any  deaths  from  the  use  of  pen- 
tazocine ? 

Dr.  Seevers.  Not  to  my  knowledge.  There  have  been  a  few  re- 
ported cases  of  drug  dependence. 

Mr.  Perito.  Directing  attention  to  your  statement  about  synthetic 
substitutes  for  codeines;  do  we  now  have  a  single  drug  which  will 
effectively  substitute  for  codeine  or  do  we  have  to  use  a  combination 
of  drugs  ? 

Dr.  Seevers.  Well,  we  have  a  compound  which  is  a  little  more 
]3otent:  dihydrocodeinong.  This  has  been  used  but  since  it  is  more 
potent,  it  is  more  subject  to  abuse.  But  it  is  not  entirely  synthetic. 

The  search  for  a  codeine  substitute  has  been  one  of  the  primary 
aims  of  industry  in  the  last  decade.  It  is  easy  enough  to  find  substi- 
tutes for  morphine  because  we  have  got  a  Avhole  list  of  them.  But 
those,  that  hPvVe  sufficiently  low  potency,  that  they  could  be  used  as 
codeine  is  used,  with  minimal  addiction  potential,  is  something  we 
have  not  quite  achieved. 

Chairman  Pepper.  Just  one  question.  Doctor,  how  do  you  think  we 
can  best  induce  organized  medicine  to  accept  a  synthetic  substitute 
for  morphine  and  codeine  ? 

Dr.  Seevers.  I  don't  think  we  will  have  any  trouble  with  morphine. 
The  problem  would  be  with  codeine  because  it  is  so  widely  used.  In 
fact,  the  amount  of  morphine  used  in  this  country  is  very  small  com- 
pared to  the  use  of  Demerol  or  other  synthetics.  The  vast  bulk  of 


16 

strong  narcotic  use  is  ^Yith  drugs  other  than  morphine  at  the  present 
time. 

Chairman  Pepper.  Well,  we  expect  to  contact  and  elicit  a  response 
from  the  American  Medical  Association  on  this  matter. 

(The  correspondence  referred  to  above  follows :) 

[Exhibit  No.  1] 

American  Medical  Association, 

Chicago,  III.,  July  9, 1911. 
Mr.  Pattl  L.  Pekito, 

Chief  Counsel,  Select  Committee  on  Crime,  House  of  Representatives, 
Congress  of  the  United  States,  Washington,  B.C. 

Dear  Mr.  Perito:  This  is  in  response  to  your  letter  requesting  our  opinion 
concerning  the  substitutability  of  synthetic  drugs  for  codeine  and  morphine.  At- 
tached to  this  letter  is  a  brief  review  of  various  available  synthetic  drugs.  As  you 
will  note  from  the  conclusions  stated  therein,  it  is  our  opinion  that  at  the  present 
time  no  drug  is  fully  satisfactory  as  a  substitute  for  morphine  or  codeine. 

We  indeed  appreciate  the  concern  of  the  committee  in  its  efforts  to  find  a 
means  of  curtailing  the  drug  abiise  problem  prevalent  today,  and  I  want  to  assure 
you  that  the  medical  profession  is  also  desirous  of  attaining  this  goal.  We  do 
not  believe,  however,  that  removing  moTphine  and  codeine  from  the  physicians' 
drug  armamentarium  is  an  appropriate  remedy.  We  strongly  recommend  that 
these  drugs  should  remain  available  to  physicians  so  that  their  patients  will  not 
be  deprived  of  the  valuable  benefits  of  these  drugs. 

Thank  you  for  the  opportunity  of  providing  our  views,  and  we  would  appreciate 
this  letter  and  memorandum  being  included  in  the  record  of  your  hearings.  If  we 
can  be  of  further  assistance  to  the  committee,  we  shall  be  pleased  to  do  so. 
Sincerely, 

Richard  S.  Wilbur,  M.D. 
[Attachment] 

MORPHINE   substitutes 

Thousands  of  compounds  have  been  synthesized  and  tested  in  the  search  for 
a  substitute  for  morphine.  In  addition  to  analgesic  potency,  this  search  has 
focused  on  lack  of  addiction  liability  as  a  primary  objective.  To  date,  these  efforts 
have  not  been  completely  successful,  although  some  advances  have  been  made. 

At  the  present  time,  nine  strong  analgesics,  that  are  prepared  synthetically  (i.e., 
not  derived  from  opium)  are  available  on  the  market.  These  are  : 

1.  Levorphanol  Tartrate  (Levo-Dromoran), 

2.  Methadone  Hydrochloride  (Dolophine). 

3.  Meperidine  Hydrochloride  (Demerol). 

4.  Pentazocine  (Talwin). 

5.  Alphoprodine  Hydrochloride  (Nisentil). 

6.  Anileridine  Phosphate  (Leritine). 

7.  PiminO'dine Esylate  (Alvodine). 

8.  Fentanyl  (Sublimaze). 

9.  Methotrimeprazine  (Levoprome). 

Meperidine  was  the  first  of  this  group  to  be  introduced  and  although  earlier 
it  was  thought  to  be  nonaddicting.  later  it  was  found  to  have  an  addiction 
liability  approaching  that  of  morphine.  Nevertheless,  it  is  the  most  widely  used 
of  the  strong  analgesics.  This  may  suggest  that  it  is  capable  of  substituting  for 
morphine  in  many  cases ;  however,  it  is  recognized  that  meperidine  Is  not  an 
adequate  sub.stitute  in  certain  ca.ses,  e.g.,  acute  myocardial  infarction. 

Several  of  the  available  compounds  are  chemically  related  to  meperidine,  drug 
numbers  5-8  in  the  above  list.  These  were  prepared  in  the  attempt  to  improve 
on  the  properties  of  meperidine.  The  actions  of  these  drugs  are  generally  similar 
to  those  of  meperidine,  and  although  each  has  individual  characteristics,  which 
limits  its  use  in  certain  conditions,  none  is  superior  to  meperidine,  and  like  it 
none  of  these  would  be  an  adequate  substitute  for  morphine  in  all  cases. 

Both  levorphanol  tartrate  (Levo-Dromoran)  No.  1  and  methadone  hydro- 
chloride (Dolophine)  No.  2,  are  effective  strong  analgesics  and  have  other 
properties  in  common  with  morphine,  including  addiction  liability ;  however,  in 


17 

practice,  experience  has  indicated  that  neither  would  meet  the  requirepients  in 
all  cases  of  an  adequate  morphine  substitute. 

The  newest  member  of  this  group  is  No.  4  pentazocine  (Talwin).  It  is  the 
only  one  with  a  low  addiction  potential,  being  less  than  that  of  codeine ;  thus, 
it  is  not  subject  to  the  controls  of  the  narcotic  laws.  Although  pentazocine  is  an 
effective  strong  analgesic,  as  with  all  other  drugs  in  this  group,  in  certain  cases, 
morphine  would  be  preferable.  Additional  compai-ative  studies  are  necessary  to 
fully  evaluate  the  potential  use  of  this  new  drug,  particularly  in  relation  to 
the  older  drugs. 

Compound  9,  methotrimeprazine  (Levoprome),  differs  chemically  from  all 
others  of  this  group,  being  a  phenothiazine  derivative  and  related  to  the  anti- 
psychotic group  of  drugs.  Although  it  does  have  strong  analgesic  properties, 
its  side  effects  of  marked  sedation  and  hypotension  greatly  limit  its  uses  and 
would  prevent  it  from  being  an  daequate  substitute  for  morphine. 

Most  controlled  studies  with  these  drugs  have  been  conducted  to  determine 
equivalent  analgesic  potencies  (i.e.,  milligram  dosage),  and  have  been  carried 
out  in  only  a  few  types  of  pain,  e.g.,  postoperative,  cancer.  Their  broader  use- 
fulness in  a  variety  of  painful  conditions  has  been  determined  by  clinical 
experience. 

On  the  basis  of  this  evidence  it  is  concluded  that,  taken  as  a  whole,  the 
group  of  available  strong  analgesics  could  be  substituted  for  morphine  in  some 
cases ;  however,  no  single  agent  of  this  group  is  capable  of  substituting  alone 
for  morphine.  At  present,  evidence  from  experimental  studies  are  not  available 
to  define  the  preferred  drug  in  each  case.  Many  additional  comparative  studies 
and  further  experience  are  necessary,  particularly  with  newer  agents  like 
pentazocine,  to  determine  their  ultimate  efiicacy  in  various  conditions.  Further- 
more, there  are  certain  situations,  e.g.,  acute  myocardial  infarction,  adjunct 
to  anesthesia  in  cardiac  surgery,  pulmonary  edema  of  heart  failure,  certain 
cancer  patients,  in  which  none  of  the  synthetic  analgesics  are  capable  of  satis- 
factorily replacing  morphine. 

CODEINE   SUBSTITUTES 

To  act  as  a  satisfactory  substitute  for  codeine,  a  drug  would  need  to  have 
the  following  properties : 

1.  Analgesic  activity. 

2.  Antitussive  activity. 

3.  Oral  effectiveness. 

4.  Low  addiction  potential. 

Of  the  presently  available  drugs  none  possesses  all  of  these  properties;  how- 
ever, it  is  not  necessary  for  a  comiwund  to  have  both  analgesic  and  antitussive 
properties  to  be  useful.  Those  drugs  that  have  one  or  more  of  these  properties 
are  considered  individually  below  from  the  standpoint  of  a  potential  codeine 
substitute. 

Propoxyphene  (Darvon)  is  an  orally  effective  analgesic  but  it  is  less  potent 
than  codeine  and  would  not  provide  pain  relief  comparable  to  codeine  in  many 
cases.  Propoxyphene  has  low  addictive  liability  but  no  antitussive  activity. 

Pentazocine  (Talwin)  lacks  antitussive  activity  but  possesses  the  other  three 
properties  necessary  to  substitute  for  codeine.  However,  insuflBcient  compara- 
tive data  are  presently  available  to  fully  evaluate  its  potential  as  a  substitute 
for  codeine  as  an  oral  analgesic. 

Several  agents  are  marketed  as  antitussive  agents :  these  are  orally  effective 
and  have  no  or  low  addiction  potential.  The  most  widely  used  of  this  group  is 
dextromethorphan.  Although  it  and  the  others  of  this  group  may  be  adequate 
for  relief  of  the  milder  types  of  cough,  i.e..  associated  with  the  common  upper 
respiratory  infections,  they  would  be  inadequate  for  severe  cough.  For  use 
in  this  situation,  a  strong  analgesic  with  antitussive  activity  such  as  methadone 
may  be  required,  but  this  drug  has  a  greater  addiction  liability  than  codeine. 

In  conclusion,  no  other  single  drug  has  all  the  properties  of  codeine :  thus, 
none  would  be  a  satisfactory  substitute.  That  other  drugs  have  some  of  the 
properties  of  codeine  is  recognized,  but  an  adequate  substitute  for  codeine's 
use  either  as  an  analgesic  or  antitussive  is  not  available  at  present. 

NARCOTIC   ANTAGONISTS 

The  use  of  the  narcotic  antagonists  in  addition  to  morphine  and  codeine 
would  be  affected  by  a  ban  on  opium  and  opium  derivatives.  Two  of  the  three 


18 

available  narcotic  antagonists  are  prepared  from  opium  derivatives.  These 
are  nalorphine  (Nalline)  and  naloxone  (Narcan),  the  other,  levallorphan  (Lor- 
phan)  is  prepared  synthetically.  The  properties  and  uses  of  nalophine  and  leval- 
lorphan are  similar  and  the  latter  could  substitute  for  the  former.  However, 
the  actions  of  naloxone  differ  from  those  of  the  other  two  agents  and  is  con- 
sidered the  drug  of  choice  in  treatment  of  overdosage  of  a  narcotic.  Even  more 
significant  are  the  studies  showing  that  naloxone  has  promise  in  the  treatment 
of  heroin  addiction  :  thus,  to  ban  the  source  of  this  drug  would  deprive  the 
medical  profession  of  a  useful  drug. 

Cliairman  Pepper.  Mr.  Mann,  have  you  a  question  ? 

Mr.  Maxx.  I  am  very  much  interested  in  tlie  action  of  the  Economic 
and  Social  Council  of  the  United  Nations  in  almost  outlawino-  syn- 
thetic narcotics.  You  imply  here  that  the  economic  factor  was  the  main 
factor  involved.  What  other  motivating  factors  do  you  see  in  that 
almost-action? 

Dr.  Seevers.  Well,  I  don't  really  know.  This  got  doAvn  to  a  l^attle 
between  the  producing  and  manufacturing  nations  and  those  that  were 
most  interested  in  the  synthetics.  I  don't  know  of  any  other,  except 
traditional.  Many  of  these  changes  have  been  in  this  business  for  a  long 
time.  Change  would  be  resented  in  countries  where  producing  has  been 
going  on  for  a  long  time.  There  is  a  manpower  problem  as  well  as 
substitution — finding  some  crop  that  would  substitute  for  opium. 

Mr.  Mann.  Do  you  think  the  medical  community  is  prepared  for 
the  legislative  outlawing  of  morphine  ? 

Dr.  Sefa'ers.  I  don't  believe  so.  Although  morphine,  itself,  isn't  used 
so  much,  I  think  the  biggest  rebellion  is  codeine.  The  reason  I  say  that, 
is  because  we  have  had  a  somewhat  analogous  situation  with  amphet- 
amines. Amphetamines  as  a  chass  of  drugs  are,  in  my  opinion,  the  most 
dangerous  drugs  of  all  available  for  abuse.  We  know  from  a  practical 
point  of  view  that  the  production  of  amphetamines  greatly  exceeds  any 
legitimate  medical  need.  But  if  you  pose  this  question  to  orgnnized 
medicine,  which  w^e  have  had  occasion  to  do,  even  in  our  committee — 
I  attended  a  meeting  of  the  AMA  committee  in  Chicago  on  Saturday 
of  last  week — even  among  the  committee  there  are  questions  as  to 
whether  we  could  get  along  without  these.  I  personally  think  we  could. 

But  you  will  not  find  a  consensus  on  these  matters. 

Chairman  Pepper.  Excuse  me.  Will  the  gentleman  yield  right  at  that 
point  ? 

]Mr.  Mann.  Yes,  sir. 

Chairman  Pepper.  Doctor,  this  committee  last  year  offered  an  amend- 
ment in  the  House,  which  was  later  adopted  by  the  Senate,  proposing 
that  there  be  a  production  quota  system  for  amphetamines  imposed 
by  the  Department  of  Justice  on  the  recommendation  of  tlie  Depart- 
nient  of  Health,  Education,  and  Welfare.  Do  you  think  that  was  a 
l^roDer  nroposal  ? 

Dr.  Seevers.  Well,  it  is  in  the  right  direction.  I  am  not  sure  whether 
it  would  accomplish  the  objective  you  seek. 

The  only  country  that  has  really  been  successful  in  controlling  am- 
phetamines, as  I  mentioned  earlier,  is  Japan.  Sweden  has  also  adopted 
a  complete  ban  in  the  sense  that  even  a  medical  use  is  restricted  to  a 
few  speci-^lists.  Three  of  the  Australian  states  have  done  this  recently. 
These  nations  have  all  done  it  in  response  to  a  rising  and  hazardous 
abtise  problem  with  amphetamines. 


19. 

I  think  a  quota  would  be  better  than  nothing,  but  I  am  not  sure  this 
would  really  solve  the  problem. 

Chairman  Pepper.  Mr.  Mami,  I  interrupted  you. 

Mr.  IVLvNN.  No  further  question. 

Chairman  Pepper.  Mr.  Wiggins  ? 

Mr.  Wiggins.  Doctor,  if  Congress  should  ban  the  importation  of 
morphine,  should  that  law  have  an  immediate  effective  date  or  should 
it  have  a  delayed  application  ? 

Dr.  Seevters.  Well,  off  the  top  of  my  head,  I  would  say  that  time  is 
not  very  important.  It  might  be  delayed  long  enough  to  work  out  some 
alternative,  but  I  don't  see  that  much  would  be  gained  by  delay,  except 
possibly  the  codeine  problem. 

]\Ir.  WiGGixs.  Yes.  You  indicated  that  substitutes  for  morphine  are 
available.  Are  they  available  in  sufficient  commercial  quantities  to 
meet  the  necessary  commercial  need  or  should  the  industry  be  per- 
mitted a  period  of  time  to  get  into  that  kind  of  production? 

Dr.  Seevers.  I  think  that  would  probably  be  wise,  but  we  have 
enough  variety  of  these  compounds  of  synthetic  origin  at  the  present 
time  that  I  don't  think  we  would  have  any  significant  shortage,  if 
there  was  a  reasonable  time. 

Mr.  Wiggins.  Are  those  synthetic  substitutes  typically  manufac- 
tured in  the  United  States  ? 

Dr.  Seevers.  They  are.  The  principal  one  is  sold  under  the  commer- 
cial name  of  Demerol.  I  don't  know  what  the  current  total  consump- 
tion or  total  use  of  this  substance  is  in  the  United  States,  but  at  one 
time  about  50  percent  of  the  strong  analgesic  was  done  with  this  drug. 
It  is  comparatively  simple  to  produce.  I  don't  think  there  would  be  a 
serious  problem. 

Mr.  Wiggins.  If  Congress  should  enact  a  statute  prohibiting  the 
importation  of  morphine  could  you  suggest  any  exce]:)tion  we  should 
make  to  that  statute  ? 

Dr.  Seevers.  Not  really. 

Mr.  Wiggins.  Oft'hand,  it  occurs  to  me  that  you  would  like  to  con- 
tinue your  scientific  studies  and  others  doubtless  would  too. 

Dr.  Seevers.  I  think  this  could  be  done  and  it  would  be  necessary. 
Morphine  is  still  used  as  a  standard  by  which  we  compare  all  other 
drugs.  I  think  a  certain  amount  of  research  should  be  carried  on.  But 
as  far  as  general  medical  use  is  concerned,  I  can't  think,  offhand,  of 
exceptions  for  medical  use. 

Mr.  Wiggins.  Is  it  your  feeling  that  if  we  excepted  necessary  sci- 
entific research  we  could  impose  an  absolute  ban  on  the  importation 
of  morphine  ? 

Dr.  Seevers.  It  would  be  possible.  I  am  not  sure  it  will  solve  your 
problem. 

Mr.  Wiggins.  Are  the  medical  consequences  tolerable  ? 

Dr.  Seevers.  From  a  medical  point  of  view,  I  think  the  answer  is 
yes.  _  ;    ' 

Mr.  Wiggins.  That  is  all,  Mr.  Chairman. 

Chairman  Pepper.  Mr.  Steiger  ? 

Mr.  Steiger.  Thank  you,  Mr.  Chairman. 

Doctor,  did  Japan  treat  a  marihuana  problem?  I  guess  first,  do 
they  have  a  marihuana  problem,  and  if  they  did,  did  they  treat  it? 


20 

Dr.  Seevers.  They  have  a  rising  marihuana  problem.  They  have 
never  had  much  abuse  of  marihuana  in  Japan,  although  it  grows  wild 
all  over  Japan.  But  they  have  become  concerned  about  it  now  to  the 
point  where  one  of  the  people  in  the  Ministry  said  they  are  thinking 
about  cutting  it  off  at  the  root  right  now,  which  implied  there  would 
be  stricter  penalties  rather  than  lesser  penalties. 

A  good  bit  of  this  problem  has  been  brought  back  into  Japan  by 
returning  American  servicemen  who  are  there  for  recreation.  The 
Ministry  is  frank  enough  to  say  this,  but  abuse  of  marihuana  is  also 
spreading  now  to  the  younger  people,  and  there  have  been  a  consider- 
able number  of  seizures  of  smuggled  hashish.  Some  of  it  is  smuggled 
in  from  Korea  and  other  areas,  and  also  from  Vietnam.  So  they  have 
had  an  increasing  number  of  users  in  the  last  couple  of  years. 

Mr.  Steiger.  It  is  illegal  ? 

Dr.  Seevers.  It  is  illegal. 

Mr.  Steiger.  Have  we  developed,  or  is  there  any  research  which 
points  to  the  potential  development  of  any  oral  antagonists  at  this 
point?  They  are  all  injected  ? 

Dr.  Seevers.  Practically  all  of  them  are  injected.  We  have  some  that 
can  be  used.  The  trouble  with  these  antagonists,  and  this  has  been  the 
real  problem,  is  that  they  produce  unpleasant  subjective  responses, 
much  like  the  hallucinogens.  Individuals  have  weird  dreams,  and 
weird  thoughts,  and  the  like.  This  has  been  one  of  the  principal  ob- 
jections to  the  use  of  the  antagonist  class  of  drugs. 

Mr.  Steiger.  I  should  think  that  would  help  sell  them. 

Dr.  Seevers.  These  effects  are  not  sufficiently  pleasant.  Most  of 
them  are  the  type  of  perceptive  distortions  that  they  leally  don't  want. 

Mr.  Steiger.  Doctor,  to  your  knowledge,  how  long  have  ampheta- 
mines been  in  use  medically,  not  the  illegal  use  or  the  abusive  use, 
but  how  long  have  amphetamines  been  in  use  ? 

Dr.  Seevers.  It  is  back  to  the  early  1930's  as  I  recall. 

Mr.  Steiger.  That  long? 

Dr.  Seevers.  Yes. 

Mr.  Steiger.  Do  you  know  if  our  military  still  issues  the  morj^hine 
ampules  they  used  to  issue  to  people  in  the  field,  or  do  we  use  Dem- 
erol, or  one  of  these  others  ? 

Dr.  Seevers.  I  don't  know  what  the  present  state  of  the  military 
is  in  this  respect. 

Mr.  Steiger.  Thank  you,  Doctor. 

Chairman  Pepper.  Mr.  Winn  ? 

Mr.  Winn.  Thank  you,  Mr.  Chairman. 

Doctor,  on  page  6  you  say :  "Whereas  we  do  have  effective  substitutes 
for  codeine  which  are  safe,  they  have  made  relatively  little  inroads 
in  the  prescribing  of  codeine." 

yiy  question  is  why  ? 

Dr.  Seevers.  I  suppose  it  is  natural  conservatism  of  medicine. 
Codeine  has  always  been  known  traditionally  as  the  weak  analgesic. 
It  has  become,  by  general  use,  to  be  a  constituent  of  many  mixture? 
in  small  amounts,  and  medicine  is  one  of  the  most  conservative 
professions. 

If  a  drug  gets  off  on  the  wrong  foot,  medicine  just  looses  interest 
in  it.  I  refer  to  a  compound  we  are  all  familiar  with  today,  methadone. 


21 

When  methadone  was  first  introduced  into  the  field  by  Lilly  &  Co. 
it  was  introduced  under  the  trade  name  of  Dolophine.  They  thouojht 
the  drug  was  much  more  potent  than  it  actually  is.  Dolophine  was 
introduced  on  a  3 -milligram  dose  basis  whereas  we  know  the  drug 
has  about  the  same  potency  as  morphine,  and  the  average  dose  is  10  mil- 
ligrams. Dolophine  fell  flat.  If  Lilly  had  introduced  it  at  a  10-milli- 
gram  dose  we  might  have  had  methadone  substituting  for  morphme. 

Methadone  is  one  of  the  drugs  that  can  satisfactorily  substitute 
for  morphine. 

Mr.  Winn.  How  many  years  ago  did  Lilly  come  out  with  that,  sir? 

Dr.  Seevers.  That  was  the  midfifties,  as  I  recall,  just  around  the 
midfifties. 

Mr.  Winn.  Would  you  encourage  the  pharmaceutical  houses  to  get 
a  press  campaign  or  campaign  put  together  so  that  they  can  use  the 
substitutes  for  codeine  ? 

Dr.  Seevers.  That  is  a  $64  question.  I  don't  know  whether  I  could 
give  an  answer  to  that. 

Mr.  Winn.  Well,  I  am  saying  do  you  think  it  would  be  wise  to  do 
that. 

Dr.  Seevers.  For  them  to  initiate  a  campaign  ? 

Mr.  Winn.  Yes. 

Dr.  See\^rs.  I  don't  know  who  would  do  the  initiating,  whether  the 
competitors  would  initiate  or  whether  producers  would  do  the  initiat- 
ing. I  doubt  the  practicality. 

Mr.  Winn.  Thank  you,  Mr.  Chairman. 

Chairman  Pepper.  ^Ir.  Keating? 

Mr.  Keating.  No  questions,  Mr.  Chairman. 

Chairman  Pepper.  Doctor,  two  questions.  One,  this  committee  has 
had  testimony  from  many  sources  that  there  are  some  8  billion  amphet- 
amines produced  and  distributed  in  this  country  every  year,  and  we 
have  been  advised,  as  has  the  Committee  on  Interstate  and  Foreign 
Commerce,  Subcommittee  on  Health,  that  about  half  of  those  go  into 
the  black  market.  Would  you  tell  us  what,  in  your  opinion,  is  the 
medical  need,  if  any,  for  amphetamines  in  this  country  ? 

Dr.  Seevers.  In  my  opinion  the  need  is  relatively  small.  I  think  this 
is  a  concensus  of  most  people  who  reviewed  the  problem.  The  biggest 
use  is  in  the  treatment  of  obesity.  At  best,  this  use  can  be  said  to  only 
temporarily  be  effective.  The  reason  for  this  is  that  tolerance  develops 
to  its  continued  exposure.  Bigger  and  bigger  doses  are  necessary.  With 
susceptible  individuals,  but  not  in  all  cases,  they  are  likely  to  become 
dependent  upon  it. 

Chairman  Pepper.  Would  you  put  the  need  in  hundreds,  or  thou- 
sands, or  millions  ? 

Dr.  Seevers.  Compared  to  8  billion  ? 

Chairman  Pepper.  Yes. 

Dr.  Seevers.  Well,  that  is  pretty  difficult.  The  only  thing  I  can  say 
is  that  as  far  as  I  can  determine,  in  Japan,  Sweden,  and  the  three 
Australian  States,  medicine  hasn't  been  hurt  very  badly. 

Chairman  Pepper.  You  would  say  the  medical  need  is  small  ? 
''   Dr.  Seevers.  Comparatively  small. 

Chairman  Pepper.  One  other  question.  You  have  spoken  about  the 
probable  reluctance  or  probable  tardiness  of  the  medical  profession  in 
accepting  these  synthetic  substitutes  for  morphine  and  codeine.  We  all 


22 

recogrnize  vre  professional  people  are  reluctant  to  change  from  a  habit 
or  course  that  we  have  been  foUowinir.  But  would  it  te  desirable  to  put 
in  perspective  the  necessity  of  balancin<r  the  harm  that  this  country 
derives  from  the  abuse  of  these  drusrs,  the  heroin  that  is  smugorled  into 
this  comitry,  the  terrible  cost  in  lives  and  other  expenditures  as  distin- 
guished from  the  inconvenience  or  perhaps  some  of  the  imperfection 
in  the  use  of  these  substitutes?  Would  it  be  desirable  for  the  medical 
profession  to  balance  those  two  interests  in  making  this  decision? 

Dr.  Seevers.  I  think  the  answer  to  that  question  is  a  tangential  one. 
You  would  have  to  sell  the  profession  on  the  notion  that  doing  this 
would  accomplish  the  objectives  that  you  seek.  In  other  words,  when  we 
have  so  many  synthetic  drugs  available,  if  there  is  a  market,  for  ex- 
ample, suppose  you  abolish  illegal  heroin  or  illegal  niorphine  or  wipe 
out  all  morphine,  we  know  that  there  are  many  places  in  the  world  that 
have  no  respect  for  patents,  they  can  make  these  synthetic  compounds 
with  relative  simplicity  and  they  are  equally  subject  to  abuse.  I  think 
the  real  question  is  whether  you'^simply  replace  one  bad  situation  with 
another  one. 

I  think  it  would  be  necessary  to  convince  the  profession  as  a  whole 
that  the  objectives  that  you  seek  would  be  accomplished. 

Chairman  Pepper.  Doctor,  we  are  profoundly  grateful  to  you  for 
bringing  your  knowledge  and  experience  to  the  benefit  of  this  com- 
mittee and  helping  our  Congress  and  country  try  to  find  some  solution 
to  this  terrible  narcotics  problem. 

I  think  counsel  wants  to  put  in  the  record  your  original  finding 
here. 

Mr.  Perito.  Mr.  Chairman,  may  we  include  in  the  record  the  cur- 
riculum vitae  of  Dr.  Seevers  ? 

Chairman  Pepper.  Without  objection,  it  will  be  so  received. 

(Dr.  Seever's  curriculum  vitae  follows:) 

[Exhibit  No.   2] 

Curriculum   Vitae  of  Dr.   Maurice  H.   Seevers,   Chairman,   Department  of 
Pharmacology,   University  op  Michigan   Medical   School 

Date  of  birth,  October  3, 1901,  Topeka,  Kans. 
Education : 

Washburn  College  (Topeka.  Kans.),  1920-1924  (A.B.) 
University  of  Chicago,  1924-1928  (Ph.  D.,  pharmacology) 
University  of  Chicago   (Rush  Medical),   (4  year  certificate)   19.30;    (M.D.) 
1932 
Internship,  University  of  Wisconsin  General  Hospital,  1930-1932 
Appointments : 

Research  fellow,  pharmacology,  Chicago,  1926-1928 
Instructor,  pharmacology,  Loyola  (Chicago),  1929 
Assistant  professor,  pharmacology,  Wisconsin,  1930-1934 
Associate  professor,  pharmacology,  Wisconsin.  1934-1942 
Visiting  associate  professor,  pharmacology  (summer  1941),  Chicago 
♦Professor  of  pharmacology  and  chairman  of  the  department  of  pharmacol- 
ogy, the  University  of  Michigan  Medical  School.  1942- 
Associate  dean,  the  University  of  Michigan  Medical  School,  1947-1950. 
Memberships  and  committees : 
♦National  Research  Council 

Committee  on  Problems  of  Drug  Dependence  (formerly  Committee  on 

Drug  Addiction  and  Narcotics)   1946-1968:  Consultant— 196&- 
Subcommittee  Anesthesiology  (Committee  on  Surgery),  194»-1957 


23 

♦American  Society  of  Pharmacology  and  Experimental  Therapeutics,  1930- 
Council,   1937;   membership  committee,   1942,   1943,   1944    (chairman); 
president,  1946,  1947;  nominating  committee,  1949,  1950   (chairman) 
♦American  Physiological  Society,  1933- 

Federation  of  American  Societies  of  Experimental  Biology  Executive 

Committee,  1946,  1947  (chairman),  1948 
Society  for  Experimental  Biology  and  Medicine  Council,  1950-1953 
♦American  Medical  Association 

Vice-chairman,    Section   of   Experimental   Medicine   and   Therapeutics 

1951-1052 
Chairman,  1952-1953 

Member,  Council  on  Drugs  (formerly  Council  on  Pharmacy  and  Chem- 
istry) 1952-1962 
*  Member — Committee   on   Alcoholism  and   Drug   Dei>endence — Council   on 

Mental  Health,  1964- 
♦Chairman — Committee  on  Research  on  Tobacco  and  Health  AMA-ERF 
1964- 

Honorary  memberships : 

♦American  Society  of  Anesthesiology. 
♦Japanese  Pharmacological  Society. 

Committees  and  consultantships : 

Member — Board  of  Scientific  Counselors,  National  Heart  Institute,  Na- 
tional Institutes  of  Health,  1957-1960. 

Member — Drug  Abuse  Panel,  President's  Advisory  Committee — White 
House  Conference  on  Narcotic  and  Drug  Abuse,  1962-1963. 

Member — Surgeon  General's  Committee  on  Smoking  and  Health,  Depart- 
ment of  Health,  Education,  and  Welfare,  1962-1963. 

Chairman — Committee  on  Behavioral  Pharmacology — Psychopharmacology 
Service  Center-National  Institutes  of  Health,  1964-1968. 

♦American  coordinator — U.S.  Japan  Cooperative  Program  on  Drug  Abuse — 
National  Science  Foundation  and  Japan  Society  Promotion  of  Science, 
since  1964. 

♦Member — President's  Commission  on  Marihuana  and  Drug  Abuse,  1971-72 
(established  by  Public  Law  91-513) . 

Editorial : 

Board  of  publication  trustees,  American  Society  for  Pharmacology  and  Ex- 
perimental Therapeutics,  1948,  chairman,  1949-1961. 

Editorial  board.  Physiological  Reviews,  1943-1951. 

Editorial  board.  Proceedings  Society  for  Experimental  Biology  and  Medi- 
cine, 1944-1959. 

Editorial  committee.  Annual  Review  of  Pharmacology,  1959-1962. 

International : 

♦WHO  (United  Nations)  Expert  Advisory  Panel  on  Drugs  Liable  to  Pro- 
duce Addiction,  1951- 

Second  Medical  Mission  to  Japan,  May-June,  1951  Unitarian  Service  Com- 
mittee and  Department  of  the  Army. 

U.S.  National  Committee  for  International  Union  of  Physiological  Science, 

Chairman  American  team— Conference  on  Physiologic  and  Pharmacologic 

Basis  of  Anesthesiology— Japan,  April-May  1956. 
Consultant— Minister  of  Public  Health  of  Thailand— Bangkok,  May  2-17, 

1959 
♦Consultant,  Minister  of  Health  and  Welfare  of  Japan,  Tokyo,  1963-. 

Awards : 

Third  Class  of  the  Order  of  the  Rising  Sun  6f  Japan,  1963. 

Distinguished   Service   Award   Washburn   University   Alumni   Association, 

1964.  ^^  .„„_ 

Second  Class— Order  of  the  Sacred  Treasure  of  Japan,  1967.^ 
Henrv  Russell  Lecturer— The  University  of  Michigan,  196 (. 
J   Y.  Dent  Memorial  Lecturer— Kings  College-University  of  London,  1968. 
Certificate    of   Commendation    from   Minister   of    State    Director-Geneial, 

Prime  Ministers  Office,  Japanese  Government,  October  1969. 


•Current  appointments. 


24 

(The  following  letter  was  received  for  the  record.) 

[Exhibit  No.  3] 

Assistant  Secretary  of  Defense, 

Washington,  D.C.,  June  28,  1971. 
Hon.  Claude  Pepper, 
House  of  Representatives, 
Washington,  B.C. 

Dear  Mr.  Pepper  :  This  is  in  reply  to  your  letter  of  June  7  in  which  you  re- 
quested our  views  on  the  use  of  opium  derivative  drugs  in  the  military  medical 
services  and  statistical  data  representing  procurement  and  issues  of  these  drug 
items,  as  well  as  synthetic  pharmaceuticals  with  similar  effects. 

"A  consensus  of  military  medical  opinion  on  the  need  for  opium  derivative 
drugs  to  treat  casualties  in  the  field  and  in  hospitals."  It  is  the  consensus  of 
the  Military  Medical  Departments  that  opiate  drugs  have  an  established  place 
in  medical  practice  and  cannot  adequately  be  replaced  by  any  other  substances. 
The  need  for  opiate  drugs  is  predicated  on  the  pi-inciple  that  the  highest  pos- 
sible quality  of  medical  care  should  be  rendered  to  military  personnel  and  their 
dependents.  While  it  is  true  that  there  are  many  occasions  when  the  synthetic 
analgesic  drugs  would  suffice,  there  is  also  a  substantial  number  of  indications 
where  the  opiate  drugs  are  clearly  superior.  For  example,  it  has  not  been 
demonstrated  that  the  synthetic  drugs  are  equal  in  efficacy  to  the  opiates  in 
myocardial  infarction,  acute  pulmonary  edema,  and  in  relief  of  pain  in  the 
severely  wounded. 

"A  consensus  of  military  medical  opinion  on  (a)  the  use  of,  and  (b)  the  ef- 
fectiveness of  synthetic  analgesic  substitutes  to  treat  casualties  in  the  field  and 
in  hospitals."  The  synthetic  analgesics  have  a  significant  and  increasing  use- 
fulness in  treating  casualties  in  the  field  and  in  hospitals.  However,  there  re- 
mains a  substantial  proportion  of  casualties  in  whom  the  opiate  drugs  are  clear- 
ly preferable.  In  addition,  many  of  the  synthetic  analgesics  have  only  a  very 
short  period  of  experience  with  their  use  and  it  would  be  unwise  to  restrict 
medical  practice  by  relying  solely  on  these  newer  compounds. 

"A  consensus  of  military  medical  opinion  on  the  advisability  of  eliminating 
opium  derivative  drugs  and  the  substitution  of  synthetic  analgesics."  It  would 
be  inadvisable  to  eliminate  opiate  drugs  from  medical  and  surgical  practice.  It 
Is  evident  that  the  amount  of  opiate  drugs  used  could  be  greatly  curtailed  by 
substitution  of  the  synthetic  drugs.  However,  the  total  removal  of  opiates  from 
medical  practice  would  result  in  less  than  optimum  treatment  of  countless  in- 
dividuals having  life-threatening  diseases  and  injuries. 

Statistical  data  representing  procurements  and  issues  of  centrally  managed 
opium  derivative  drugs,  as  well  as  synthetic  pharmaceuticals  with  similar  ef- 
fects, is  attached  as  enclosure  1.  This  data  represents  the  latest  4  complete  fiscal 
years.  Data  prior  to  fiscal  year  1967  is  not  available.  Miss  Hastings  of  your 
staff  agreed  to  the  submission  reflecting  this  period  of  time. 

Although  most  of  the  opium  derivative  drugs  are  procured  and  issued  to  the 
military  medical  services  by  the  Defense  Supply  Agency,  larger  medical  facilities 
locally  procure  nonstandard,  slow  moving  opium  derivative  drugs.  These  facil- 
ities are  all  registered  with  the  Bureau  of  Narcotics  and  Dangerous  Drugs. 

Attached  as  enclosure  2  is  a  copy  of  the  regulation  "Safeguarding  of  Sensi 
tive.  Drug  Abuse  Control,  and  Pilferable  Items  of  Supply"  as  per  your  request. 

The  Veterans'  Administration  does  not  procure  these  items  from  the  Depart- 
ment of  Defense.  The  Veterans'  Administration  has  its  own  procurement  system 
and  buys  these  items  directly  from  vendors. 

There  are  no  separate  regulations  or  security  precautions  applicable  to  syn- 
thetic analgesics  versus  opium  derivatives.  The  governing  factor  in  this  instance 
is  whether  the  Bureau  of  Narcotics  and  Dangerous  Drugs  has  classified  the  item 
in  one  of  five  schedules  for  controlled  substances.  If  so.  security  measures  are 
required  ;  however,  these  items  are  dispensed  by  prescription  only. 

I  trust  this  information  will  be  of  assistance  to  you  and  the  committee. 
Sincerely, 

Louis  M.  Roussei.ot,  M.D.,  F.A.C.S. 


25. 

I'BOCUREMENT     AND     ISSUE     DATA     FOB     CENTRALLY     STOCKED     OpIUM     DERIVATIVE 

Drugs  and  Synthetic  Analgesics  With   Similar  Effects 

The  information  in  tliis  enclosure  is  qualified  as  follows  : 

1.  Procurement  quantities  are  indicated  by  the  fiscal  year  in  which  contracts 
w^ere  awarded  (or  delivery  orders  processed).  Actual  delivery  to  DSA  depots 
and  subsequent  issue  to  DSA  customers  does  not  normally  correspond  to  these 
fiscal  years.  In  addition  tlo  Army,  Navy  and  Air  Force  units,  the  DSA  has  in- 
teragency agreements  to  supply  medical  materiel  directly  to  the  following 
Federal  agencies :  NASA,  USAID,  D.C.  Government,  U.S.  Coast  Guard,  FAA  and 
GSA.  Certain  Army,  Navy  and  Air  Force  units  also  supply  directly  to  other  Fed- 
eral and  foreign  agencies.  For  example,  the  Republic  of  Vietnam  Armed  Forces 
and  USAID  in  Vietnam  are  supplied  with  medical  materiel  from  the  U.S.  Army 
Medical  Depot  in  Okinawa. 

2.  In  some  cases,  procurement  and  issue  data  do  not  appear  to  be  related.  This 
can  occur  when  items  are  being  phased  out  of  the  distribution  system  or  new 
items  are  added  to  the  armamentarium.  Further,  changing  mobilization  reserve 
materiel  objectives  may  be  responsible. 

3.  Only  those  forms  of  propoxyphene  containing  at  least  65mg  are  included. 

4.  Methadon  is  n(jt  managed  centrally  as  yet. 


1967 


Fiscal  years — 


1968 


1969 


1970 


6505-114-8950— Codeine  sulfate  tablets,  NF,  32  mg.,  20's: 

Procured  by  DPSC ^ 24,700 

Issued  to: 

Army _ _ ._  4,797 

Navy 1,678 

Air  Force 640 

IVIAP 20 

Other  = _..  3 

6505-114-8975— Codeine  sulfate  tablets,  NF,  32  mg.,  lOO's: 

Procured  by  DPSC 92,016 

Issued  to: 

Army ^fek 9,525 

Navy 9,420 

Air  Force. 9,088 

MAP 9.803 

Others 14,987 

6505-615-8979— Codeine  phosphate,  USP,  1  oz.  (28.35  gm.): 

Procured  by  DPSC 2,502 

Issued  to: 

Army 5,306 

Navy - _.  1,752 

Air  Force 576 

MAP...,. 144 

Oth^ir 19 

6505-864-8092— Codeine    phosphate   injection,    USP,    30    mg. 
cartridge-needle  unit  1  cc,  20's: 

Procured  by  DPSC  i 

Issued  to: 

Army.... 2,610 

Navy.. 1,367 

Air  Force 1,071 

MAP. L-. 0 

Other  2 0 

6505-864-8091— Codeine    phosphate    injection,    USP,    60    mg., 
cartridge-needle  unit  1  cc,  20's: 

Procured  by  DPSC .^^..^ ic..: 4,230 

Issued  to:  ^     '  = 

Army 1,181 

Navy 1,293 

Air  Force. 732 

IVIAP . 0 

Other 0 

6505-929-8986— Hydromorphine,    HOI     injection,     NF,    2    mg. 
cartridge-needle  unit  1  cc,  20's: 

Procured  by  DPSC 10,200 

Issued  to: 

Army _' 0 

Navy 0 

Air  Force 19 

MAP 0 

Other 0 

See  footnotes  at  end  of  article. 


3,638 

1,818 

1,454 

297 

203 

22 

366 

126 

52 

4 

7 

474 

1 

7 

3 15,  593 

75,816 

96,336  .. 

47,  481 

55,  344 

14,811 

8,980 

9,405 

8,470 

9,514 

10,  581 

9,759 

9,508 

5,407 

22,012 

236 

2,614 

2,221 

11,808 

2,304  .. 

5,016 

2,043 

4,111 

1,126 

1,312 

664 

1,753 

2,106 

1,433 

21 

25 

85 

76 

109 

27 

9,600 

11,430  .. 

3,278 

5,366 

1,260 

994 

1,532 

418 

1,166 

2,057 

1,085 

19 

63 

86 

9 

56 

171 

2,040 

11,100... 

1,542 

1,410 

840 

1,482 

2,009 

771 

882 

1,211 

889 

14 

40 

25 

14 
0 

56 

59 
2,520 

1,483 

1,160 

927 

586 

1,274 

800 

750 

1,196 

1,440 

0 

1 

0 

9 

24 

15 

60-296 — 71— pt.  1- 


26 


Fiscal  year; 

i— 

1967 

1968 

1969 

1970 

6505-132-3030-Paregorlc,  USP,  1  pt.  (473  cc): 

Procured  by  DPSC  '                              - 

69,792  -. 

39, 936 

92,  776 

3,715 

5,706 

3,556 

424 

64,  368 

Issued  to: 

Army. - - 

Navy 

Air  Force          

25,  773 
2,691 
7,497 

18,813 
496 

23,  598 

4,499 

6,484 

4,017 

339 

3,960 
2,618 
4,658 

MAP 

Other  2 - 

6505-129-5000— Morphine  sulfate  tablets,  USP,  8  mg.,  20's: 

Procured  by  DPSC                  

7,658 
168 

Issued  to: 

Army --- 

Navy - 

Air  Force - 

MAP 

Other -..- ------ 

6505-129-5500— Morphine  sulfate  tablets,  USP,  16  mg.,  20's: 

Procured  by  DPSC                  --- 

4,428 

852 

110 

50 

73 

235 

323 

34 

5 

920 

65  ... 
21  ... 
78  ... 

4  ... 
32  ... 

Army - 

Air  Force - -- 

3,924 
996 
1,265 
3,460 
4,432 

226,250  .. 

663 

233 

793 

1,772 

20 

3,181  ... 

1,411  ... 

318  ... 

0  ... 

4  ... 

Other 

6505-129-5517— Morphine  injection,  USP,  16  mg.,  1.5  cc: 

Prnnirori  bv  DPSC  1                                                           .. 

Army. _ - - 

Navy - - - 

Air  Force      -. 

2,096 

2,974 

36,  206 

0 

2,500 

258,500  .. 

22,  782 
11,601 

6,019 
12,921 

1,483 

25,  387 

3,744 

4,599 

50 

0 

24,  805 
4,057 

604 
6,023 

949 

39,  892 

2,132 

11,549 

370 

0 

25, 193 

12,  897 

1,162 

8,719 

4,112 

11.160 

12,203 

9,132 

MAP.--. 

Other'                                       -- 

105 
18,  000 

6505-129-5518— Morphine  injection,  USP,  16  mg.,  1.5  cc,  5's: 
Procured  bv  DPSC                                          

Army - 

5,259 
6,363 

Air  Force                            

292 

MAP--- 

Other - 

Procured  bv  DPSC                                      

15,603 
1,840 

Army. - - - 

Navy --- 

Air  Force                              

597 

594 

537 

20 

0 

4,500 

1,606 

741 

588 

0 

1 

5,820 

3,626 

2,053 

2,559 

5 

267 

3,660 

2,623 

1,750 

1,753 

0 

1 

201 

530 

310 

0 

0 

4,380 

1,757 

1,391 

614 

28 

9 

28,  335 

11,737 

3,592 

3,257 

4 

185 

9,420 

3,734 

2.300 

2,139 

20 

92 

178  ... 
152  ... 
191  ... 

0  ... 

0  ... 

3,360 

1,672 

973 

695 

5 

53 

5,640  ... 

Other. - 

6505-864-7617— Morphine  injection,  USP,  8  mg.,  cartridge-needle 
unit,  1  cc,  20's: 

2,500 

Issued  to: 

Navy -- 

905 
618 
784 

MAP                              - 

1 

146 

6505-864-7618— Morphine  injection,  USP,  15  mg., cartridge-needle 
Procured  bv  DPSC                            -       ..     

Issued  to: 

Army - 

Air  Force        

6,133 

2,138 

2,978 

33 

217 

10,590 

4,247 

2,473 

2,652 

2 

59 

3,299 
2,549 
3,265 

MAP 

Other           - 

9 

141 

unit,  1  cc,  20's: 

4,328 

Issued  to: 

Navy 

2,816 
2,515 
3,020 

MAP         

8 

6505-435-8477— Pentazocine  lactate  injection.  Equivalent  of  30 
mg.  of  pentazocine,  1  cc,  syringe-needle  unit  lO's: 
I   Procured  bv  DPSC  '                                               .  

50 
5,184 

Army                                                                   

3 

13 

k\T  Torce                                                                 _  

2 

2 

other  2 - - 

7 

See  footnotes  at  end  of  article. 


27 


Fiscal  years— 


1967  1968  1969  1970^ 


678 

19,  789 

179 

18,  432 

669 

13,281 

20 

154 

276 

799 

6505-689-5513— Pentazocine  lactate  injection.  Equivalent  to  30 
mg.  of  pentazocine  per  cc,  10  cc: 

Procured  by  DPSC... - - - 43,200  46,656 

Issued  to: 

Army _ .-. 

Navy._ - - 

Air  Force - -- 

MAP _ ..- - -- 

Other 

6505-477-4655— Fentanyl   citrate   injection.   Equivalent  to   0.05 
mg.  of  fentanyl  per  cc,  2  cc,  12's: 

Procured  by  DPSC _ 1,296 

Issued  to: 

Army _ 

Navy - - - _ 

Air  Force - 

MAP. - _ 

Other - 

6505-477-4667— Fentanyl  citrate  and  droperidol  injection,  5  cc, 
12's: 

Procured  by  DPSC  i 1,728 

Issued  to: 

Army.. _ 

Navy ___ 

Air  Force 14 

MAP 

Others _ _.. _ ' 

6505^84-6183— Fentanyl  citrate  and  droperidol  injection,  2  cc, 
12's: 

Procured  by  DPSC _ _ _ 1,728 

Issued  to: 

Army _ _ ___ 

Navy _ _ 

Air  Force _ _._ § 

MAP 

Other 

6505-958-2364— Propoxyphene  HCI  capsules,  USP,  65  mg.,  500's: 

Procured  by  DPSC 35,520  28,080           18,336             17,664 

Issued  to: 

Army 9,741  13,841           12,629             11,865 

Navy 3,303  4,953             5,758               8,304 

Air  Force 5,255  5,719             6,821               7,248 

MAP 0  44                  57                    92 

Other.... 98  161               348                 165 

6505-913-7907— Propoxyphene     HCI,     aspirin,     caffeine,     and 
phenacetin  capsules,  lOO's: 

Procured  by  DPSC  1 10,224 3,660                 500 

Issued  to: 

Army 2,994  49               904             2  749 

Navy 129  213                 30                 188 

Air  Force 33  41                116                  307 

MAP 0  34                  60                    24 

Others..-. 0  524                793               2,465 

6505-784-4976— Propoxyphene  HCI,  aspirin,  caffeine,  and  phen- 
acetin capsules,  500's: 

Procured  by  DPSC 78,048  158,208         131,688            27,792 

Issued  to: 

Army 31,782  68,946           71,995            29,776 

Navy... 14,392  23,853           31,896            28,162 

Air  Force 20,399  25,837           31,928            32,927 

MAP 0  441                 962                  985 

Other... _ 653  562             2,318                  840 

6505-082-2651— Meperidine  HCI  injection,  NF,  75  mg.,  cartridge- 
needle  unit,  1  cc,  20's: 

Procured  by  DPSC 4,680  7,380              2  640 

Issued  to: 

Army 1,313  3,178            2,298              1,938 

Navy 936  716            1,587                 528 

Air  Force. 1,195  2,045             1,694              1,354 

MAP- 0  11                  36                   15 

Other...- _ 0  1               181                   84 

6505-082-2652— Meperidine  HCI  injection,  NF,  75  mg.,cartridge- 
.needle  unit,  1  cc.,20's: 

-      Procured  by  DPSC  1 13,200  8,730           19,200              8,820 

Issued  to:  ■,.  ,       ,- 

Army ..AQ..'il>.:'.'iil.:: -  2,401  4,986            7,151              6,346 

Navy 1,505  2,362            2,900              3,355 

AirForce. ■  2,455  2,809            3,658              4,749 

MAP 0  18                    6                     6 

Others 225  167                102                 133 


See  footnotes  at  end  of  article. 


28 


Fiscal  years- 


1967      1968      1969       1970 


6505-126-9375— Meperidine  HCI  tablets  NF,  50  mg.,  lOO's: 

Procured  by  DPSC 13,536             5,904             6,480               7,920 

Issued  to: 

Army --- - 4,052 

Navy..-. 2,295 

Air  Force ----  2,048 

MAP 1,788 

Other.. - ---- ----  631 

6505-126-9360— Meperidine  HCI  injection  NF,  50  mg.,  per  cc,  cc: 

Procured  by  DPSC .- 93,744 

Issued  to: 

Army -...:. 20,298 

|\|avy                                                   24,448 

Air  Force 17,907 

MAP - 4,392 

Other 3,455 

6505-864-8093— Meperidine   HCI    injection,   NF,   100   mg.,  car- 
tridge-needle unit,  1  cc.  20's: 

Procured  by  DPSCi 3,830 

Issued  to: 

Army... ---. 1.920 

Navy.. 1.926 

Air  Force 1.558 

MAP 0 

Other  2 2 

6505-854-8094— Meperidine  HCI  injection,  NF,  50  mg.,  cartridge- 
needle  unit,  1  cc,  20's: 

Procured  by  DPSC ..--  21,270 

Issued  to: 

Army --- 4,616 

Navy - 2,715 

Air  Force ---  3,410 

MAP 0 

Other 157 

6505-864-8095— Meperidine  NCI  injection,  NF,  100  mg.,  cartridge- 
needle  unit,  1  cc,  20's: 

Procured  by  DPSC. ^p '. .-  4,200 

Issued  to: 

Army.-.. .---  4,243 

Navy .-- .---  3,177 

Air  Force 2,825 

MAP .--  30 

Other - 148 

6505-864-8095— Meperidine  HCI  injection,  NF,  50  mg.,  cartridge- 
needle  unit.  1  cc,  20's: 

Procured  by  DPSC 11,340 

Issued  to: 

Army 765 

Navy.. 615 

Air  Force 855 

MAP 

Other  2 2 


1,311 
1,460 
1,919 
1,456 
38 

2,862 

1.573 

1,956 

140 

39 

1,222 

1,095 

1,586 

1,458 

352 

63,720 

59,184  ... 

34,803 

16,144 

12,305 

5,378 

128 

24,  870 

13,709 

8,681 

48 

165 

6,892 
8,977 
5,228 
3,696 
89 

3,300 

12,720 

4,740 

2,792 
754 

2,152 

625 

98 

2,830 
1,338 
2,339 
1,106 
224 

2,060 
1,011 
1,657 
2,555 
386 

13,  860 

27,  840 

18,180 

8,846 

2,825 

3,963 

100 

150 

10,873 

3,167 

5,146 

64 

175 

9,835 

3,295 

6,228 

51 

190 

9,300 

18,  540 

8,888 

7,654 

3,399 

2,830 

119 

138 

5,305 

2,980 

3,714 

8 

60 

5,817 
3,244 
4,066 

1 
44 

4,260 

10,020 

4,140 

3,651 

1,269 

2,383 

339 

136 

4,481 

1,289 

2,240 

7 

132 

1,139 

1,396 

1,977 

65 

147 

» The  difference  between  quantities  procured  and  total  issued  is  caused  by  the  exclusion  in  this  tabulation  of  the  in- 
ventory on  hnnd  (beginning  FY  1957)  and  the  inventory  required  to  be  retained  as  depot  stocks  at  the  end  of  FY  1970. 

2  Other  type  customers  are  non-DoD.  In  order  of  user  magnitude:  AID  and  Public  Health  about  the  same.  Coast  Guard, 
State  Departnient.  etc. 

3  Item  deleted  May  1,  1970,  This  quantity  transferred  to  property  disposal. 

(Enclosure  2  was  retained  in  the  committee  files.) 

Chairman  Pepper.  Our  next  Tvntness  is  a  man  so  eminently  qnalified 
to  spealv  on  the  subject  of  drug  abuse  that  I  could  spend  a  good  i>art 
of  the  rest  of  this  hearing  just  listing  his  qualifications. 

The  committee  is  pleased  and  honored  to  welcome  Dr.  Nathan  B. 
Eddy. 

Dr.  Eddy  holds  a  doctor  of  medicine  degree  from  the  Cornell  Uni- 
versity Medical  School  and  an  honorary  doctor  of  science  degree 
from  the  University  of  Michigan. 


29 

Dr.  Eddy  began  his  career  with  the  practice  of  medicine  in  New 
Yoi-k  City  in  1911.  Since  then,  he  has  been  an  instructor  of  physiology 
;it  McGili  University;  an  assistant  professor  of  physiology  and  phar- 
macology at  the  University  of  Alberta;  visiting  investigator  at  the 
department  of  pharmacology,  Cornell  University  Medical  School; 
visiting  investigator  and  lecturer,  department  of  physiology,  the  Uni- 
versity of  Michigan:  consultant  biologist  in  alkaloids  to  the  U.S. 
Public  Health  Service;  principal  pharmacologist.  National  Institutes 
of  Health;  chief  of  the  Section  of  Anal<resics,  Laboratory  of  Chemis- 
try.  National  Institute  of  Arthritis  and  IMetabolic  Diseases  of  the  Na- 
tional Institutes  of  Health.  The  last  position  he  held  before  he  sup- 
posedly retired  in  1960.  Since  his  retirement,  he  has  served  as  a  con- 
sultant on  narcotics  to  the  National  Institutes  of  Health ;  the  Executive 
Secretary  and  currently  Chairman  of  the  Committee  on  Drug  Addic- 
tion and  Narcotics  of  the  Medical  Division  of  the  National  Research 
Council ;  consultant  to  the  Bureau  of  Narcotics  and  Dangerous  Drugs; 
consultant  to  the  New  York  State  Narcotic  Addiction  Control  Com- 
mission, and  consultant  to  the  Le  Dain  Commission  on  Nonmedical 
Uses  of  Drugs. 

Dr.  Eddy  is  a  member  of  numerous  honorific  and  professional  asso- 
ciations and  has  served  on  countless  committees  concerned  with  drug 
addition,  lioth  in  this  country  and  for  the  United  Nations. 

Dr.  Eddy's  awards,  all  well  deserved,  are  legion.  Some  of  the  groups 
which  have  honored  him  are  the  U.S.  Public  Plealth  Service,  the 
World  Health  Organization,  the  Eastern  Psychiatric  Research  Asso- 
ciation, and  the  American  Social  Health  Association. 

Dr.  Eddy  has  authored  and  coauthored  more  than  150  books  and 
articles  on  a  variety  of  subjects. 

'^  Dr.  Eddy,  with  his  considerable  experience  in  pharmacology  and 
physiology,  will  testify  today  on  the  present  availability  of  synthetic 
drugs  to  replace  morphine  and  codeine. 

It  is  indeed  a  great  honor  to  have  you  with  us  today,  Dr.  Eddy, 

Mr.  Perito,  our  chief  counsel,  will  inquire. 

Mr.  Perito.  Dr.  Eddy,  I  understand  you  have  a  prepared  statement. 

STATEMENT  OF  DS.  NATHAN  B.  EDDY,  CHAIRMAN.  COMMITTEE 
ON  PROBLEMS  OF  DRUG  DEPENDENCE,  DIVISION  OF  MEDICAL 
SCIENCES,  NATIONAL  ACADEMY  OF  SCIENCES-NATIONAL  RE- 
SEARCH COUNCIL 

Dr.  Eddy.  Mr.  Chairman,  I  prepared  a  statement  for  the  committee 
which  might  be  called  a  series  of  thumbnail  sketches  of  potential 
alternatives  to  morphine  and  codeine. 

I  think  it  would  take  considerable  time  and  be  repetitious  of  a  good 
deal  of  technical  detail  to  read  that  statement.  With  your  permission, 
I  would  prefer  to  make  some  pertinent  statements  of  pertinent  facts 
and  principles  and  afterward  elaborate,  if  you  wish,  and  answer  ques- 
tions so  far  as  I  can  on  points  which  have  not  been  covered. 

Chairman  Pepper.  Proceed  as  you  will,  Dr.  Eddy. 

Dr.  Eddy.  It  is  a  privilege  indeed  to  be  here  today  and  speak  on  the 
question  of  the  replaceability  of  the  natural  opiates  direct  and  indirect. 
By  direct  I  mean,  of  course,  morphine  and  codeine  which  occur  natu- 


30 

rally  in  opium.  By  indirect,  the  substances  which  are  derived  from 
morphine  and  codeine  by  modification  of  one  sort  or  another,  such 
as  hydrocodone,  hydromorphone,  oxymorphone,  oxycodone,  and 
heroin,  which,  of  course,  is  paramount  in  the  problems  of  drug 
dependence. 

Let  me  start  off  by  saying  unequivocally  that  the  natural  opiates, 
direct  and  indirect,  can  be  replaced  by  synthetic  substances  presently 
available.  I  am  not  alone  in  this  belief.  Dr.  Seevers  has  already  so 
stated  and  I  believe  Dr.  Brill  will  concur  in  this  opinion.  Also,  as 
Dr.  Seevers  indicated,  the  Committee  on  Drug  Addiction  and  Narcot- 
ics, now  the  Committee  on  Problems  of  Drug  Dependence  of  the 
National  Research  Council,  has  on  at  least  four  occasions  adopted 
resolutions,  the  sense  of  which  is  the  same. 

Referring  to  the  descriptions  which  were  in  the  statement  prepared 
for  the  committee  on  specific  alternates,  these  cover  a  wide  range,  not 
so  wide  strictij  speaking  from  the  chemical  standpoint,  but  a  wide 
range  in  potency  when  we  think  in  terms  of  dosage  only.  There  are  also 
some  variations  in  the  surrounding  j)roperties  of  the  various  com- 
pounds. We  have  compounds  which  are  several  times — I  am  talking 
about  compounds  which  are  presently  available  on  the  market — we 
have  compounds  several  times  more  potent  than  morphine;  levor- 
phanol,  for  example,  which  is  like  morphine  in  all  essential 
respects  and  equally  dependence-producing.  We  have  phenazo- 
cine,  somewhat  different  chemically,  which  is  also  several  times  more 
potent  than  morphine  and  shows  a  slightly  reduced  dependence  poten- 
tial. It  has  not  become  very  popular  because  the  difference  is  not  as 
great  quantitatively  as  hoped  in  the  beginning. 

We  also  have  potential  substitutes  which  are  less  effective  dose  wise 
than  morphine.  The  most  popular  of  these  is  Demerol,  or  meperidine, 
or  pethidine.  It  has  40  or  50  different  names  around  the  world.  It  is 
only  about  one-sixth  to  one-eighth  as  potent  as  morphine,  thinking  only 
of  dosage.  It  is  equally  dependence-producing.  As  a  matter  of  fact,  it  is 
my  personal  opinion  relative  to  its  pain-relieving  properties  it  has  a 
greater  dependence  potential  than  does  morphine  itself. 

Then  we  have  pentazocine,  which  is  quite  different  from  Demerol 
in  its  chemistry  and  belongs  to  a  new  class  of  compounds  to  be  referred 
to  in  somewhat  more  detail  in  a  moment.  It  is  about  one-fourth  as 
potent  as  morphine.  It  has  essentially  no  physical  dependence  potential 
or  such  physical  dependence  potential  as  it  possesses  is  of  a  different 
type  from  that  of  morphine.  It  does  have  subjective  effects  which  a 
few  people  have  found  to  their  liking,  especially  if  they  have  been 
abusing  other  drugs  and  there  are  a  small  number  of  cases  of  abuse  of 
pentazocine  reported.  Pentazocine  is  being  accepted  to  a  verj^  consider- 
able extent  by  the  medical  profession:  its  sale  is  increasing  and  it  is 
proving  to  be  a  quite  effective  compound. 

There  is  a  difference  in  these  compounds  with  respect  to  their  rela- 
tive oral  and  parenteral  use,  oral  and  subcutaneous  or  intramuscular 
use.  The  first  I  mentioned,  levorphanol,  is  equally  effective  by  mouth 
as  by  injection.  Practically  all  of  the  others  are  less  effective  by  mouth 
than  by  injection.  Ppntazocine  perhaps  is  another  exception,  the  range 
between  its  oral  and  parenteral  dose  is  narrower  than  for  most  of  the 
other  compounds. 


31 

I  have  been  involved  in  this  problem  of  trying  to  find,  or  trying  to 
disassociate,  the  dependence  properties  and  the  useful  pain-relieving 
properties  of  compounds  which  we  could  use  in  place  of  morphine  for 
some  40  years.  It  has  been  a  most  frustrating  effort  for  most  of  that 
time  until  we  discovered,  partly  by  accident,  as  the  result  of  a  sugges- 
tion I  made  in  another  connection,  that  certain  chemical  modifications 
of  morphine-like  substances  produced  at  the  same  time  the  ability  to 
relieve  pain  or  possessed  at  the  same  time  the  ability  to  relieve  pain 
and  the  ability  under  some  circumstances  to  antagonize  the  effects  of 
morphine  itself.  The  first  of  them  was  nalorphine.  Many  like  com- 
pounds, or  many  compounds  in  this  class,  have  been  made  since  then, 
as  Dr.  Seevers  pointed  out.  These  antagonists,  the  compounds  with 
antagonistic  potentiality,  have  little  or  no  i^hysical  dependence  capac- 
ity. Such  physical  dependence  capacity  as  they  possess  is  of  a  different 
type  from  that  produced  by  morphine.  Their  subjective  effects  are 
different  and  in  most  people  are  exceedingly  unattractive.  We  call  these 
compounds  agonist-antagonists  and  pentazocine  is  an  important 
example. 

To  reiterate,  I  believe  that  it  is  possible  to  replace  the  natural  opiates 
with  synthetic  substances.  The  question  is:  Is  it  practical?  At  the 
present  time  I  think  the  answer  has  to  be  "no,"  because  we  have  to 
take  so  many  other  things  into  account  other  than  the  mere  ability 
to  replace  one  compound  with  another  without  interfering  with  medi- 
cal practice  or  without  damage  to  the  patient.  As  a  matter  of  fact, 
we  might  even,  with  some  of  these  substitutes,  improve  the  conditions 
with  respect  to  the  patient. 

Again,  the  answer  is  "no,"  if  we  are  thinking  simply  in  terms  of 
saying  you  cannot  have  the  natural  opiates,  but  must  use  the  synthetics. 
We  banned  heroin  in  this  country  from  medical  practice,  but  that  did 
not  ban  it  from  the  illicit  market.  The  illicit  market  in  heroin  is  still 
increasing. 

As  I  said,  I  have  been  working  in  this  held  for  40  years,  hoping  that 
some  day  we  could  say  we  can  get  along  without  opium.  Today  we 
can  say  that,  medically,  we  can  get  along  without  opium,  but  I  am 
not  at  all  sure  that  we  should  say  it  in  just  that  way,  without  qualifi- 
cation. If  I  may  make  a  suggestion,  I  think  we  can  say  to  the  world 
at  large,  the  time  has  come  wlien  we  should  be  putting  every  effort  into 
economic  and  technical  assistance  to  the  opium  farmer  so  that  he  can 
live  by  the  production  of  other  crops  and  without  the  production  of 
opium.  Meanwhile,  we  are  going  to  continue  to  study  the  agonist- 
antagonists  because  I  think  pentazocine  can  be  further  improved  upon 
and  we  are  going  to  continue  to  pursue  other  lines  of  chemical  investi- 
gation, which  in  some  instances  already  promise  compoimds  which  are 
not  antagonists  but  which  have  reduced  the  dependence  potential. 

Some  people  like  practically  every  drug,  or  for  practically  every 
drug  there  are  some  people  who  like  it,  no  matter  how  adverse  it 
seems  to  most  of  us.  We  call  this  craving  or  liking  a  psychic  depend- 
ence. I  am  very  pessimistic  about  our  ever  eliminating  completely 
psychic  dependence.  We  can  and  we  have  eliminated  the  ability — or 
produced  compounds  which  have  eliminated  the  ability — to  produce 
physical  dependence.  We  can  do  something  about  the  individuals  lik- 
ing for  other  things,  like  his  abuse  of  other  things,  and  we  can  improve 
the  situations  so  far  as  drug  abuse  in  medical  practice  is  concerned. 


32 

We  can,  I  think,  most  helpfully  go  back  to  the  source,  the  opium 
source,  and  try  to  do  more  than  we  have  done  about  the  overproduc- 
tion, especially  the  illicit  production,  of  opium  to  reduce  the  availa- 
bility of  compounds  for  abuse. 

Chairman  Pepper.  Doctor,  did  I  understand  you  to  say  tliat  you 
thought  we  could  now  scientifically  develop  an  antagonistic  drug  to 
heroin  which  would  give,  as  Dr.  Seevers  indicated,  a  relative  immunity 
of  sensation  to  tlie  addict  in  the  taking  of  heroin  ? 

Dr.  Eddy.  We  already  have  such  compounds. 

Chairman  Pepper.  If  that  could  be  put  into  mass  use,  then  that  would 
to  a  large  degree  remove  the  desire  for  the  taking  of  heroin,  I  ])resume, 
from  the  addict  ? 

Dr.  Eddy.  Well,  the  answer  isn't  quite  as  simple  as  that.  We  can 
antagonize  the  effects  of  heroin.  We  can  prevent  the  individual  from 
getting  a  response  to  his  taking  of  heroin.  We  don't  necessarily,  by 
the  same  token,  remove  his  desire  to  take  heroin.  We  can  prevent  the 
heroin  from  having  any  effect  upon  him,  but  we  don't  necessarily,  at 
the  same  time,  prevent  him  from  wanting  to  have  that  effect. 

Chairman  Pepper.  ]SIr.  Wiggins  wishes  to  ask  a  question. 

Mr,  Wiggins.  Doctor,  I  am  confused.  Why  would  a  person  take  two 
drugs  that  would  have  the  net  effect  of  taking  none?  I  gather  that 
there  are  antnironists  that  neutralize  heroin? 

Dr.  Eddy.  That  is  right. 

Mr.  WiGGixs.  Which  has  the  effect  of  not  taking  heroin. 

Dr.  Eddy.  That  is  right. 

IVIr.  WiGGixs.  So  why  not,  just  in  terms  of  the  logic  of  it,  avoid  tak- 
ing heroin  in  the  first  instance? 

Dr.  Eddy.  Well,  they  generally  do.  If  you  can  persuade  them  to  take 
the  antagonist  even  though  they  want  the  subjective  effects  of  the 
hei^oin  or  another  opiate.  The  problem  is  to  s:ei:  them  to  take  something 
v/hich  they  know  is  going  to  prevent  them  from  getting  the  kick  they 
want.  The  people  who  have  been  put  on  the  antagonists,  they  don't 
necessarily  take  your  word  for  it  that  they  are  not  going  to  get  any 
kick  out  of  their  heroin,  and  they  may  go  back  and  try  heroin  until 
they  find  that  this  is  futile.  If  they  have  got  any  sense  they  are  going 
to  say,  "Well,  I  am  throwing  mj^  money  away."  And  as  long  as  you  can 
keep  them  on  the  antagonist  they  cannot  get  an  effect  out  of  heroin  and 
hence  have  no  reason  to  abuse  heroin  or  to  go  out  on  the  street  and 
steal  televisions  and  cars  and  the  rest  of  it  to  buy  heroin. 

So  you  have  improved  the  situation  from  that  standpoint  for  them 
and  yourself.  But  you  have  to  persuade  them  to  take  the  antagonist. 

Chairman  Pepper.  Excuse  me.  Could  you  add  something  to  that 
antag'onistic  drug  to  cause  the  patient  to  get  an  unfavorable  reaction 
if,  after  taking  the  antagonistic  dnig,  he  took  heroin  ? 

Dr.  Eddy.  Well,  you  can  do  it  the  other  way  around.  If  he  is  taking 
heroin  and  you  give  him  the  antagonist  you  certainly  give  him  an  mi- 
pleasant  reaction.  I  don't  know  any  instance  wheie  he  necessarily  gets 
an  unpleasant  i-eaction  from  the  heroin  he  attempts  to  take  after  he 
has  taken  the  antagonist.  He  may  get  an  unpleasant  reaction  from  the 
antagonist  itself  until  you  stabilize  him  on  it. 

Mr.  Wiggins.  Does  the  antagonist  have  any  effect  ? 

Dr.  Eddy.  For  a  person  dependent  on  an  opiate,  the  antagonist  pve- 
cipitates  withdrawal  symptoms,  very  markedly  so.  It  is  the  same  as  if 


33 

you  had  taken  all  of  the  heroin  or  opiate  away  from  the  addict,  just' 
like  that.  He  goes  into  withdrawal  when  you  give  him  an  antagonist  if 
he  is  taking  an  opiate. 

Mr.  WiGGixs.  How  much  success  are  you  having  in  getting  people  to 
do  this  voluntarily  ? 

Dr.  Eddy.  Well,  it  hasn't  been  tried  too  widely.  There  are  two  diffi- 
culties, at  least.  One  is  that  the  most  potent  antagonist  we  have,  which 
has  been  tried,  cyclazocine,  is  likely  to  produce  unpleasant  reactions 
when  you  start  to  administer  it.  Dr.  Seevers  referred  to  these.  They 
are  quite  disagreeable.  You  have  to  proceed  rather  cautiously  with 
most  people  to  stabilize  them  on  the  cyclazocine.  They,  too,  become  tol- 
erant, accustomed  to  the  drug  so  that  these  unpleasant  reactions  disap- 
pear and  you  can  stabilize  them,  keep  them  in  a  state  where  they  can 
take  cyclazocine  day  by  day  and  be  free  from  any  adverse  symptoms. 
You  have  got  to  completeh'  withdraAv  them  from  their  heroin,  dis- 
continue their  hei'oin  administration  completely  for  several  days  before 
you  start  the  antagonist. 

That  is  one  drawback  for  that  particular  antagonist.  The  other  one 
which  has  ]:)een  used  to  the  greatest  extent  is  naloxone,  which  does  not 
produce  any  unpleasant  reactions  at  all.  It  is  as  nearly  as  we  know,  a 
pure  antagonist.  It  has  no  morphine-like  eifects  whatsoever.  Cyclazo- 
cine does  have  morphine-like  effects  under  certain  circumstances.  It  is  a 
powerful  analgesic.  It  is  on  the  order  of  40  times  more  potent  as  an 
analgesic  than  morphine  itself.  But  to  attain  its  analgesia  you  are  liable 
to  produce,  with  a  great  many  people,  these  unpleasant  side  reactions. 
So  it  is  not  a  practicable  analgesic. 

Xaloxone  is  not  an  analgesic  at  all.  It  only  produces  antagonism. 
It  is  quite  effective  when  injected,  but  it  is  very  poorly  effective  by 
mouth  and  the  doses  required  to  stabilize  the  individual  to  a  state 
where  he  would  not  get  a  reaction  from  taking  heroin  requires  very 
large  oral  doses,  and  the  duration  of  action  is  short. 

But  we  have  other  antagonists  in  the  offering,  which  we  ho[)e  to  be 
able  to  develop,  of  longer  duration  and  hopefully  as  effective  as  cycla- 
zocine, without  the  unpleasant  reactions.  This  is  the  field  in  which  a 
great  deal  of  effort  is  being  put  at  the  present  time.  Ideally,  it  would 
seem  to  me  the  way  to  go  about  it.  Practically,  as  I  say,  the  difficulty  is 
to  2:)ersuade  the  patient  to  begin  and  to  continue  the  administration  of 
the  antagonist;  but  he  must,  initially,  give  up  his  opiate  entirely  and  he 
must  take  a  compound  which  he  knows  is  going  to  prevent  him  from 
getting  any  of  the  reactions  that  he  has  been  wanting.  So  far  as  this 
can  be  done,  the  program  is  successful. 

Chairman  Pepper.  Doctor,  Mr.  Perito  has  a  question. 

Mr.  Perito.  Dr.  Eddy,  do  these  antagonists  have  an  opiate  base? 

Dr.  Eddy.  No. 

Mr.  Perito.  They  do  not  ? 

Dr.  Eddy.  No;  not  necessarily. 

The  original,  tlie  first  antagonist  that  we  are  familiar  with,  nal- 
orphine, is  a  modified  morphine.  You  can  make  similar  modifications 
in  various  of  the  synthetic  bases  which  are  used  as  analgesics,  in  levor- 
phanol,  for  example.  You  can  make  a  similar  substitution  in  levor- 
phanol  and  get  a  more  potent  antagonist  than  nalorphine.  You  can 
similarly  substitute  in  the  synthetic  phenazocine  the  same  group  and 
get  a  very  powerful  antagonist  with  very  intense  subjective  reactions, 


34 

so  intense  that  we  haven't  done  very  much  with  it.  Or  you  can  modify 
either  of  these  bases  in  other  ways  and  get  lesser  degrees  of  antagonism 
with  lesser  subjective  effects.  Pentazocine  is  such  a  compound.  It  is, 
at  the  same  time,  an  agonist;  that  is,  a  morphine-like  substance  which 
produces  the  morphine-like  relief  from  pam  and  so  on,  as  well  as 
being  a  mild  antagonist.  So  that  it  can  prevent  the  development  of 
morphine-like  dependence  or  precipitate  withdrawal  phenomena  if 
given  to  a  person  dependent  on  morphine. 

Mr.  Perito.  I  assume  the  same  would  be  true  with  cyclazocine  and 
naloxone. 

Dr.  Eddy.  Cyclazocine  is  a  modification  of  one  of  the  synthetics. 
Naloxone,  on  the  other  hand,  is  derived  by  modification  of  a  morphine 
derivative.  Therefore,  theoretically,  we  would  require  the  availability 
of  opium  in  order  to  produce  naloxone.  Actually  there  is  another 
variety  of  poppy  which  produces  one  of  the  opium  alkaloids  in  its 
natural  life  history  without  producing  morphine,  and  work  is  under- 
way to  develop  this  particular  variety  of  poppy  to  get  the  starting 
material  to  make  naloxone  without  having,  at  the  same  time,  an  over- 
supply  of  morphine. 

Even  though  naloxone  is  morphine  based,  if  I  may  put  it  that  way, 
it  is  theoretically  possible  to  come  to  it  without  having  to  go  through 
morphine  production. 

Chairman  Pepper.  Doctor,  if  we  could  eliminate  the  legitimate  need 
for  the  growing  of  the  opium  poppy,  and,  if,  as  you  suggested,  we  could 
provide  a  comparable  income  to  the  grower  of  the  opium  poppy  by 
substituting  some  other  crop  that  would  not  have  these  injurious 
effects,  do  you  think  that  would  be  in  the  public  interest  of  this  Nation 
and  the  nations  of  the  world  ? 

Dr.  Eddy.  Very  definitely  so.  If  you  reduce  the  overall  production 
you  must  increase  the  trend  toward  the  use  of  the  substitutes. 

If  I  might  refer  to  the  question  that  was  asked  of  Dr.  Seevers  with 
respect  to  the  international  situation  when  we  came  so  close  to  ban- 
ning the  synthetics  some  years  ago,  it  was  largely  an  economic  ques- 
tion. The  opium  producing  countries  were  afraid  of  the  loss  of  their 
income,  of  course,  and  they  put  forth  the  claim,  or  made  the  assertion, 
that  if  we  permitted  the  synthetics,  we  would  develop  a  greater  prob- 
lem than  we  had  in  controlling  opium,  since  we  would  develop  the 
opportunity  for  illicit  production  of  the  synthetics.  Well,  that  prob- 
lem has  not  developed  and  the  manufacturing  countries  argued  that 
thev  did  not  expect  that  it  would  develop. 

Chemistry  is  not  all  that  simple.  If  we  were  to  cut  off  the  supply 
of  opium  completely  we  might  be  faced  with  some  prol)lems  along 
those  lines,  because  we  know  now  that  there  are  illicit  manufacturers 
of  barbiturates  and  amphetamines  in  addition  to  the  licit  manufac- 
ture. So  we  can't  eliminate  completely  the  possibility  of  illicit  manu- 
facture of  synthetics  if  we  turn  to  the  synthetics  in  place  of  natural 
alkaloids. 

Chairman  Pepper.  Doctor,  from  your  knowledge  of  the  general  field 
and  of  the  sums  available  for  carrying  on  the  very  commendable  re- 
search in  finding  a  synthetic  substitute  for  morphine  and  codeine,  and 
also  for  the  finding  of  an  antagonistic  drug  to  heroin,  are  the  funds 
presently  available  adequate  to  carry  on  the  research  programs  that 
vou  think  are  desirable  ? 


35 

Dr.  Eddy.  No. 

Chairman  Pepper.  Therefore,  Avoiild  you  think  additional  Federal 
fluids  would  be  in  the  public  interest  for  these  research  programs  ? 

Dr.  Eddy.  Yes. 

Chairman  Pepper.  Mr.  Mann  ? 

Mr.  Mann.  Thank  you. 

Pursuing  this  economic  problem  just  one  step  further,  would  there 
be  any  allegation  on  the  part  of  the  opium-producing  countries  at  this 
point,  or  any  justifiable  allegation  that  the  United  States  would  have 
any  monopoly  on  the  production  of  the  synthetic  drugs,  or  that  the 
cost  of  producing  these  synthetic  drugs  on  a  legitimate  basis  would 
make  the  outlawing  of  opium  economically  bad  for  all  other  countries  ? 

Dr.  Eddy.  I  don't  think  so,  because  the  know-how  is  present  in 
other  countries  besides  the  United  States.  We  do  have  a  group  of 
manufacturing  countries  on  the  one  hand  and  presently  a  group  of 
producing  countries,  if  you  want  to  call  them  that,  the  opium  pro- 
ducers, on  the  other  hand.  But  my  suggestion  was  that  we  put  our 
effort  into  giving  the  opium  producers  and  producing  countries,  eco- 
nomic and  technical  assistance  so  they  can  live  without  opium.  We 
can't  expect  to  do  this  at  their  cost  solely.  We  have  got  to  do  some- 
thing about  getting  them  to  grow  alternative  crops.  But  once  you  have 
done  that  I  don't  see  that  they  have  any  allegation  that  we  are  taking 
the  bread  out  of  their  mouth. 

Mr.  Mann.  Nothing  further. 

Chairman  Pepper.  Mr.  Wiggins  ? 

My.  Wiggins.  Doctor,  do  you  generally  concur  in  the  observations 
made  by  Dr.  Seevers  that  if  the  Congress  were  inclined  to  prohibit  the 
importation  of  morphine  that  such  a  statute  should  have  immediate 
effect?  i-  ■  }\    >'' 

Dr.  Eddy.  Well,  I  don't  know — I  am  not  sure  that  I  know  what 
you  mean  by  immediate.  As  of  now,  no.  You  couldn't  do  it  quite  that 
quickly. 

There  is  reluctance  on  the  part  of  the  physicians  to  use  the  syn- 
thetics, justifiably  so.  They  have  been  fooled  more  than  once.  Heroin 
was  introduced  as  a  nonaddicting  substance  75  years  ago.  It  was 
promptly  proved  to  be — that  was  promptly  proved  to  be — erroneous. 
Demerol  was  introduced  30  years  ago  as  a  nonaddicting  substance,  even 
though  at  the  time  that  it  went  on  the  market  we  had  evidence  that  it 
was  as  dependence-producing  as  morphine  itself.  The  producer  dis- 
agreed and  claimed  for  a  number  of  years,  6  or  8  years,  that  we  were 
wrong,  that  it  did  not  produce  morphine-like  dependence.  Later,  they 
did  admit  that  we  were  right,  that  it  did  produce  physical  dependence, 
and  the}'  have  changed  their  advertising.  It  is  now  under  narcotic 
control — they  advertise  it  now  as  a  morphine-like  substance. 

Mr.  Wiggins.  Doctor,  we  both  understand  that  if  Congress  were  to 
await  a  medical  concensus  that  we  would  not  act  at  all,  just  because  the 
doctors  are,  as  has  previously  been  testified  to,  an  independent  lot. 
Nothwithstanding  that,  if  Congress  should  make  a  determination  that 
it  is  in  the  public  interest  to  prohibit  the  importation  of  morphine  do 
you  know  of  any  reason  why  that  statute  should  not  be  made  operative 
as  of  its  effective  date,  or  would  it  be  in  the  public  interest  to  delay  it 
a  month,  6  months,  a  year,  2  years,  something  on  that  order  ? 


Dr.  Eddy.  Well,  physicians,  usually  physicians  are  not  all  that 
familiar  with  new  products.  I  think  there  should  be  some  reasonable 
delay  in  order  to  familiarize  them  with  the  substitutes.  As  I  said 
earlier,  we  banned  heroin  from  the  medical  practice  without  too  much 
resistance,  partly  because  we  kept  morphine,  which  in  many  instances 
was  advantafjeous  over  heroin  and  heroin  was  not  all  that  popular  in 
the  United  States.  When  the  attempt  was  made  to  ban  heroin  in  Great 
Britain  there  was  a  tremendous  furor  and  the  Home  Office  eventually 
withdrew  the  ban  and  heroin  is  still  permissible  in  Great  Britain. 

If  we  were  to  attempt  to  ban,  by  congressional  action,  the  use  of 
morphine  in  clinical  medicine  I  think  there  would  very  justifiably  be 
a  fjood  deal  of  resistance  on  the  part  of  physicians.  The  natural  opiates 
are  what  they  are  accustomed  to  and  you  would  have  to  give  them  an 
opDortunity  to  become  accustomed  to  things  to  be  used  alternatively. 

Mr.  WkvOtxs.  I  have  difficulty  in  reconciling  your  statement  that 
medical  resistance  would  be  iustified  in  view  of  your  earlier  statement, 
there  are  adequate  substitutes  for  morphine  now  existing. 

Dr.  Eddy.  Well,  those  substitutes  are  there,  but  not  all  of  the  physi- 
cians in  the  country  are  aware  of  them  and  familiar  with  their  use. 
They  would  say:  "Well,  what  am  I  going  to  do  for  John  Jones  for 
whom  I  must  have  morphine  in  order  to  get  him  through  this  opera- 
tion or  to  handle  his  broken  leg  or  something  else.  I  don't  know  any- 
thing about  this  compound.  I  have  never  heard  of  it."  You  have  got  to 
give  him  an  opportunity  to  familiarize  himself,  carry  on  some  sort  of 
campaign  to  get  them  to  accept  the  alternative. 

I  was  very  active,  took  a  very  great  interest  in  the  introduction  of 
pentazocine.  It  was  quite  slow  m  coming  on  the  market  for  reasons  I 
don't  need  to  go  into.  I  was  particularly  interested  because  it  appeared 
to  be  completely  free  of  physical  dependence  factors,  and  it  is  reason- 
ably so.  We  did  not  expect  any  abuse  of  it  at  all.  There  has  been  a 
very  small  amount  of  abuse  because  a  few  people  who  have  abused 
other  drugs  have  found  the  reactions  of  it  pleasant  to  them  and  have 
gone  on  to  use  excessive  amounts,  but  the  number  is  very  small.  It 
does  have  antagonistic  properties  if  given  to  a  person  already  depend- 
ent on  morphine.  It  was  likely  the  withdrawal  phenomena  would  be 
precipitated  and  would  probably  make  him  sick  and  probably  very 
angry  with  his  doctor  if  the  doctor  w^as  not  aware  of  what  was  going 
on.  But  the  reaction  to  it  has  been  exceedingly  good.  It  is  an  agonist- 
antagonist  and  physicians  are  accepting  it,  and  I  think  we  can  get 
them  to  accept  it  and  other  compounds  of  this  sort  to  a  sufficient  ex- 
tent so  that  medical  practice  would  not  suffer  for  lack  of  the  opiates. 
But  this  takes  a  little  time. 

Mr.  Wtootns.  I  would  like  to  ask  two  additional  questions.  Doctor. 
How  would  you  describe  the  ease  of  manufacturing  the  existing  sub- 
stitutes for  morphine?  That  question  is  really  aimed  at  whether  or  not 
we  can  expect  a  lot  of  backyard  or  backroom  clandestine  laboratories 
turninir  out  the  substitutes  if  the  United  States  were  to  prohibit  the 
use  of  morphine. 

Dr.  Eddy.  Well,  none  of  the  synthetics  are  all  that  easy  to  produce. 
It  would  require  a  very  skilled,  very  well-equipped  technical  chemical 
laboratory  to  produce  them.  It  isn't  anything  like  the  ease  with  which 
heroin  is  obtained  from  morphine.  You  can  cook  up  hei-oin  in  your 


37 

kitchen  from  morpliine  if  you  have  a  morphine  supply.  You  can  ex- 
tract morphine  from  opium  without  very  much  difficulty. 

Mr.  Wiggins.  Is  it  as  easy  as  manufacturing  LSD  or  more  difficult? 

Dr.  Eddy.  Well,  given  a  supply  of  lysergic  acid  for  the  production 
of  LSD,  the  development  of  the  synthetics  in  place  of  the  natural  opi- 
ates would  be  much  more  difficult. 

Mr.  Wiggins.  What  would  be  the  price  for  synthetics  versus  price  of 
morphine? 

Dr.  Eddy.  Presently  the  price  to  the  patient  is  practically  the  same 
per  dose  for  all  the  compounds  we  have  been  considering.  We  have  al- 
ready looked  into  that. 

Mr.  Wiggins.  Thank  you,  Doctor. 

Chairman  Pepper.  Mr.  Steiger  ? 

Mr.  Steiger.  I  have  no  questions. 

Chaii-man  Pepper.  Mr.  Winn  ? 

Mr.  Winn.  Thank  you,  Mr.  Chairman. 

Doctor,  you  have  a  statement  here  which  says  you  believe  drug  de- 
toxification has  no  effect  on  a  person's  craving  for  drugs.  You  spoke  to 
that  a  minute  ago,  and  this  same  statement  says  that  is  what  you  re- 
ferred to  as  the  lesson  of  Lexington.  Could  you  speak  to  that  a  little 
bit  more? 

Dr.  Eddy.  Well,  perhaps  I  can  answer  your  question  this  way :  So 
far  as  we  know,  putting  a  patient  through  cold  turkey,  which  means 
withdrawing  from  opiate  without  any  treatment  at  all,  does  not  deter 
him  from  relapse,  relapse  to  the  use  of  opiate  once  he  is  free  of  the 
treatment  as  against  treating  him  as  humanely  as  possible.  So  there  is 
no  point — there  is  no  justification — for  cold  turkey  treatment  of  a 
drug-dependent  person. 

]\Ir.  Winn.  What  you  are  saying,  which  you  referred  to  a  little  while 
ago,  is  that  there  would  be  no  difference  in  the  psychic  craving  ? 

Dr.  Eddy.  That  is  right. 

Mr.  Winn.  And  not  a  physiological  craving  ? 

Dr.  Eddy.  We  can  handle  the  physical  dependence  side  of  it  without 
difficulty,  because  we  know  how  to  take  the  person  through  withdrawal 
so  he  does  not  suffer,  to  all  intents  and  purposes,  take  him  through 
withdrawal  with  reasonable  comfort. 

But  that  doesn't  necessarily  affect  his  remembrance  of  the  effects 
that  he  got  from  the  heroin  he  took  or  the  oj^iate  that  he  took  previ- 
ously or  his  desire  to  reexperience  those  effects.  That  is  psychic 
dependence. 

Mr.  Winn.  Are  you  doing  anything,  or  is  anything  being  clone,  to 
offset  this  psychic  dependency. 

Dr.  Eddy.  Yes;  of  course.  Any  treatment  program  should  include 
psychotherapy  to  try  to  help  the  man  to  understand  and  meet  his  prob- 
lems Avithout  resort  to  drugs  to  convince  him  that  the  subjective  effects 
which  he  obtained  were  not  essential  to  him,  that  life  without  drugs  is 
possible  and  reasonable  and  more  productive,  more  rewarding. 

Mr,  Winn.  Thank  you  very  much,  sir. 

Thank  you,  Mr.  Chairman. 

Chairman  Pepper.  Doctor.  I  understand  that  in  Britain,  one  way  of 
handling  heroin  addiction  is  to  authorize  the  prescription  of  heroin 
to  addicts.  Would  you  recommend  that  course  in  this  country  ? 


38 

Dr.  Eddy.  No. 

Chairman  Pepper.  Now,  would  you  care  to  comment  about  the  use  of 
methadone  as  a  drug  in  the  treatment  of  heroin  addiction? 

Dr.  Eddy.  In  the  use  of  methadone  you  use,  or  you  accustom,  the 
individual,  you  stabilize  the  individual  on  a  dosage  level  which, 
through  the  mechanism  of  cross-tolerance,  prevents  him  from  getting 
anj'  acute  reaction  to  the  methadone  which  he  is  taking  or  a  dose  of 
heroin  which  he  might  take.  Therefore,  you  stabilize  him  in  a  state 
where  he  is  in  a  stable  mood  so  far  as  drug  use  is  concerned  and  is  of  a 
mind  to  turn  his  attention  to  other  things  rather  than  simply  to  his 
previously  drug-seeking  behavior.  Therefore,  he  no  longer  needs  to  go 
out  in  the  street  and  steal  cars  and  televisions  and  so  on  to  buy  his 
heroin.  Ke  has  an  opportunity  to  concern  himself  with  getting  a  job 
,and  supporting  his  family. 

Mr.  Pepper.  How  do  you  think  methadone  should  be  furnished  to 
the  addict? 

Dr.  Eddy.  Through  a  team  effort  to  help  handle  all  of  his  problems, 
not  just  simply  to  supply  him  with  drugs,  because  you  must  have  the 
psychotherapy,  the  vocational  assistance,  the  job  help  and  housing 
help,  perhaps,  and  all  this  while  he  is  stabilized  on  methadone.  Other- 
wise he  has  other  reasons  for  trying  to  go  back  to  other  drugs,  even 
though  he  is  not  getting  any  satisfaction  out  of  his  heroin. 

Chairman  Pepper.  In  other  words,  a  prescription  of  methadone  by  a 
physician  is  not  the  answer  to  the  problem  alone  ? 

Dr.  Eddy.  Very  definitely  not.  Theoretically,  in  a  very  rare  instance, 
it  would  be  possible  for  a  private  physician  with  very  close  rapport 
with  his  patient  to  put  that  patient  on  methadone  and  keep  close  con- 
tact with  him  and  treat  him  satisfactorily.  But  practically,  writing  pre- 
scriptions for  drug-dependent  people  for  methadone,  letting  them  go 
to  tlie  drugstore  and  buy  it  without  doing  anything  else  for  him,  is 
not  the  answer  at  all.  You  just  give  him  the  opportunity  to  use  exces- 
sive amounts  of  methadone  or  to  sell  some  of  it  to  somebody  else,  go  to 
another  doctor  and  get  some  more.  You  have  no  control  over  the  prop- 
osition at  all.  You  have  not  accomplished  what  you  have  set  out  to  do. 

Chairman  Pepper.  Doctor,  one  other  question. 

What  is  your  opinion  as  to  the  medical  need  for  amphetamines^ 

Dr.  Eddy.  The  legitimate  need  is  very  small  indeed. 

Mr.  Wiggins.  Doctor,  what  is  the  difference  between  methadone 
maintenance  or  stabilization  and  heroin  maintenance  or  stabilization, 
assuming  the  heroin  was  made  available  at  no  cost  or  minimum  cost 
to  the  patient  ? 

Dr.  Eddy.  Theoretically,  none  when  you  supply  the  heroin.  If  you 
are  going  to  be  successful  you  have  got  to  supply  him  \yith  enough 
heroin  to  maintain  him  in  a  reasonably  stable  state.  Practically,  there 
are  differences  because  at  the  present  time  they  are  still^  sujiplying 
heroin  in  England  to  be  taken  by  injection,  which  maintains  the 
ritual  of  heroin  abuse  which  the  individual  has  been  subject  to  pre- 
viously. In  the  methadone  maintenance  program  the  drug  is  given  by 
mouth  and  therefore  you  upset  the  ritual,  which  goes  along  with  his 
dependence,  and  probably  is  a  very  significant  factor  in  the  mainte- 
nance of  dependence. 

Put  more  than  that,  you  can  build  up  to  a  dose  of  methadone  which 
will  maintain  the  individual  in  the  stable  state  throughout  the  24- 


39 

hour  period.  It  is  exceedingly  difficult  to  do  that  with  heroin  because 
heroin  is  so  short  acting  and  particularly  ineffective  by  mouth.  Meth- 
adone is  nearly  as  effective  by  mouth  as  it  is  by  injection.  Heroin  is 
much  less  effective  by  mouth.  That  is  why  they  stick  to  the  injection 
route,  and  it  would  be  exceedingly  difficult  to  stabilize  a  person  on 
heroin  given  by  mouth,  almost  impossible. 

But  theoretically  in  both  instances  you  are  simply  maintaining  the 
individual's  dependence  by  giving  him  another  opiate. 

Chairman  Pepper.  Any  more  questions  ? 

Mr.  Steiger.  Just  one. 

Dr.  Eddy,  in  your  work  with  Dr.  Seevers  in  his  primate  laboratory 
did  you  see  any  symptoms  of  the  psychic  dependence,  or  is  there  any 
method  of  observing  that  ? 

Dr.  Eddy.  There  are  programs  going  on  in  a  number  of  laboratories 
directed  toward  that  very  thing.  As  a  matter  of  fact,  we  are  very 
hopeful  that  in  the  not  too  distant  future  we  will  have  techniques  for 
measuring  drug  seeking  behavior  through  offering  the  drugs  to  the 
primates  for  self-administration.  This  is  a  very  promising  line  of  re- 
search that  is  going  on  in  Dr.  Seevers'  laboratories  and  other  labora- 
tories as  well.  It  is  a  different  approach  from  what  he  described  where 
we  were  attempting  to  assess  the  dependence  liability  of  compounds 
sent  to  him  under  code  designation. 

Mr.  Steiger.  Is  there  any  investigation  in  which  we  are  attempting 
to  support  psychic  independence  by  chemical  means?  Has  that  been 
explored?  Is  it  not  conceivable?  Is  that  a  part  of  what  you  just 
described  ? 

Dr.  Eddy.  I  am  not  sure  what  you  mean. 

Mr.  Steiger.  In  which  we  can  reach  the  psychic  dependence  chemi- 
cally or  by 

Dr.  Eddy.  Well,  you  do.  In  methadone  maintenance  or  heroin  main- 
tenance you  are  administering  the  same  type  of  drug  upon  which  the 
individual  is  dependent  psychically  and  physically,  so  you  satisfj'^  his 
psychic  as  well  as  physical  craving. 

]Mr.  Steiger.  I  understand  that.  Is  there  any  attempt  to  find  a  chem- 
ical which  will  allow  the  patient  to  overcome  the  psychic  dependence 
without  the  need  for  all  of  the  social  requirements  that  we  now  have  ? 
Is  that  not  achievable,  in  your  opinion  ? 

Dr.  Eddy.  Perhaps.  Dr.  Keats  once  said  when  he  first  began  study- 
ing the  antagonists — Dr.  Keats  is  a  very  skilled  person  in  clinical 
medicine  and  very  much  involved  with  some  of  the  new  compounds — 
he  once  said  that  perhaps  the  solution  to  our  problem  was  to  develop 
a  compound  which  made  the  individual  uncomfortable  and  yet  re- 
lieved his  pain.  If  he  could  be  persuaded  to  take  cyclazocine  as  an 
analgesic  in  the  ordinary  clinical  situation  he  would  probably  at  some 
times,  at  least,  be  pretty  uncomfortable.  He  wouldn't  like  it  very 
much.  But  if  he  got  sufficient  relief  of  pain  he  might  be  able  to  tolerate 
the  unpleasantness  until  tolerance  to  it  developed.  The  pharmaceutical 
houses  have  not  been  willing  to  take  that  gamble. 

There  is  a  related  compound,  one  of  the  synthetic  groups,  actually 
as  potent  as  cyclazocine.  I  discussed  with  the  manufacturer  the  possi- 
bility of  pursuing  it  as  a  drug  for  clinical  medicine,  hopefully  that 
there  would  be  enough  difference  between  the  dose  level  for  the  dis- 
agreeable side  effects  and  for  the  pain-relieving  effect  so  that  we  could 


40 

get  away  with  it  as  Dr.  Keats  suggested.  The  company  did  make  a 
brief  trial  but  the  results  were  even  worse  than  with  cyclazocine  and 
they  would  have  nothing  further  to  do  with  it. 

But  something  along  those  lines  may  be  possible.  Pentazocine  in 
some  circumstances,  and  in  some  individuals,  has  had  disagreeable 
side  effects  though  to  a  lesser  degree  then  cyclazocine,  but  it  is  being- 
accepted  by  physicians  and  patients  at  the  present  time.  So  in  a  sense 
we  have  accomplished  w4iat  we  are  striving  for. 

Mr.  Steigek.  Thank  you,  sir. 

Chairman  Pepper.  ]\Ir.  Keating  ? 

jMr.  Keating.  No  questions. 

Chairman  Pepper.  Mr.  Perito,  do  you  have  anything  to  put  in  the 
record  or  any  other  questions  ? 

Mr.  Perito.  Yes,  Mr.  Chairman,  I  would  like  to  offer  for  the  recoi-d 
the  prepared  statement  and  curriculum  vitae  of  Dr.  Eddy. 

Chairman  Pepper.  Without  objection  they  will  be  received. 

Dr.  Eddy,  we  wish  to  than  you  very  much  for  coming  here  and  giv- 
ing us  from  your  vast  knowledge  and  experience  the  encouraging  testi- 
mony you  have  given  us  this  morning. 

Thank  you  very  much. 

Dr.  Eddy.  It  has  been  a  privilege  and  a  pleasure  to  talk  with  you. 

(The  material  referred  to  follows : 

[Exhibit  No.  4(a)] 

Prepared  Statement  of  Dr.  Nathan  B.  Eddy,  Chairman,  Committee  on  Prob- 
lems OF  Drug  Dependence,  Division  of  Medicax  Sciences,  National  Academy 
OF  Sciences-National  Research  Council 

The  Select  Committee  on  Crime  has  seen  the  resolutions  of  the  Committee  on 
Drug  Addiction  and  Narcotics,  Division  of  Medical  Sciences,  National  Research 
Council,  the  earliest  of  which  has  been  quoted  by  Dr.  Seevers  today.  These  resolu- 
tions maintain  that  medical  practice,  and  the  patient,  would  suffer  no  loss  if  the 
natural  alkaloids  of  opium,  and  substances  derived  from  them,  were  not  available. 
All  medical  indications  for  morphine  and/or  codeine,  as  well  as  for  substances 
semisynthetically  derived  from  them,  can  be  met  by  substances  of  wholly  synthetic 
origin.  Adequate  substitution  is  possible.  Is  it  practical  or  advantageous?  Many 
considerations  must  enter  into  the  answer  to  this  question.  Dr.  Seevers  and  Dr. 
Brill  have,  or  will,  discuss  some  of  them.  Obviou^^ly  the  advantages  and  disad- 
vantages of  potential  substitutes  are  important,  so  I  offer  for  the  record  brief 
summaries  of  some  replacements  already  on  the  market.  The  presentation  is  in 
approximate  chronological  order. 

Pethidine  (meperidine,  Demerol®)  was  the  first  wholly  synthetic  morphine- 
like analgesic,  the  characteristics  of  which  were  discovered  only  incidentally. 
Close  scrutiny,  however,  revealed  that  its  structure  corresponded  ro  an  internal 
part  of  the  morphine  molecule,  hence,  presumably,  its  morphine-like  properties. 
As  with  heroin  40  years  earlier,  pethidine  was  introduced  as  not  dependence- 
producing,  a  claim  which  undoubtedly  was  of  great  importance  in  building  the 
drug's  popularity  and  is  in  vogue  among  many  physicians  even  today.  Fortunately 
we  liavc  not  again  been  so  far  off  the  mark.  The  optimal  analgesic  dose  of  pethi- 
dine, effective  against  many  types  of  pain,  is  100  nig.  approximately  equivalent 
to  10  mg.  of  morphine  when  each  is  given  intramusculary.  Pethidine  is  available 
for  oral  administration,  usually  in  combination  with  aspirin,  but  its  effective- 
ness by  this  route  is  not  as  great  as  the  small  dose  in  the  cominerical  preparation 
seems  to  indicate.  The  use  of  pethidine  is  accompanied  by  the  same  sort  of  side 
effects  as  are  associated  with  the  use  of  morpliine  witli  only  minor  quantitative 
differences.  Sleepiness  and  constipation  may  be  less  frequent,  a  feeling  of  well- 
being  more  frequent.  It  produces  respiratory  depression,  relative  to  its  analgesic 
action,  at  least  as  great  as  that  following  morphine,  and  is  probably  more  likely 
to  cause  a  fall  in  blood  pressure.  Pethidine  has  been  used  widely  in  obstetrics 


41 

and  may  facilitate  dilation  of  the  cervix,  but  it  may  also  decrease  uterine  con- 
tractions and  it  does  not  necessarily  shorten  labor.  Pethidine  has  a  significant 
effect  on  the  infant,  increasing  the  frequency  of  delay  in  first  breath  and  cry. 
This  depression  is  less  than  when  the  barbiturates  are  used  and  i)rol)abIy  less 
than  with  administration  of  morphine,  but  it  is  definite  and  should  not  be  re- 
garded lightly.  From  the  very  first  tests  for  determination  of  the  possibility, 
pethidine  has  been  shown  to  be  dependence-producing  and  many  cases  of  de- 
pendence on  it,  of  morphine  type,  have  been  reported,  especially  among  medical 
and  ancillary  personnel.  The  euphorigenic  and  dependence-producing  dose  of 
pethidine  is  close  to  its  optimal  analgesic  dose,  so  that  its  dependence  liability 
relative  to  its  analgesic  action  is  much  like  that  of  morphine. 

Methadmie  (Dolophine®),  though  apparently  dissimilar  to  morphine  in  struc- 
ture, can  produce  qualitatively  essentially  all  of  moi-phine's  actions  and  in  many 
respects  is  quantitatively  equivalent.  It  is  more  effective  than  morphine  when 
taken  by  mouth  and  its  euphorigenic  action  persists  longer  vphether  the  oral  or 
parenteral  route  is  employed.  Tolerance,  cross-tolerance,  and  dependence  develop 
as  with  morphine  and  the  side  effects  of  methadone  and  morphine  are  similar. 
The  withdrawal  syndrome  after  chronic  administration  of  methadone  develops 
more  slowly,  is  less  intense,  and  is  longer  in  duration  than  the  morphine  absti- 
nence syndrome.  Methadone  is  a  good  enough  suppressant.  There  should  be  no 
difficulty  in  using  methadone  wherever  morphine  is  indicated  but  its  abuse 
liability  is  as  great  as  with  morphine. 

Normethadonc  is  closely  similar  to  methadone  in  structure  and  action,  but 
has  been  used  only  in  a  mixture  as  a  cough  suppressant.  The  addition  of  the 
other  active  constituent  in  the  marketed  mixture,  Ticarda :  namely  Suprifen, 
does  not  reduce  abuse  liability  and  may  indeed  increase  it  because  of  its  am- 
phetamine-like stimulant  subjective  effects.  Cases  of  dependence  in  clinical  prac- 
tice have  been  described.  While  at  least  as  effective  as  codeine,  according  to  the 
usual  therapeutic  doses,  for  cough  relief,  the  abuse  liability  or  normethadone 
is  greater. 

Levorphanol  (Dromoran®)  is  a  result  of  attempts  to  synthesize  morphine  in 
the  laboratory  and  has  the  structure  minus  three  chemical  features.  It  is 
morphine-like  in  its  action  in  all  respects  and  dosewise  is  several  times  more 
powerful.  It  is  particularly  effective  when  taken  by  mouth.  Again  it  could  be 
used  for  all  morphine  indications,  but  there  would  be  no  reduction  in  dependence 
liability. 

Dea:ftrometh orphan  (Romilan®)  is  structurally  related  to  codeine  as  levorpha- 
nol is  related  to  morphine,  but  it  is  qualitatively  different  in  some  respects.  It 
does  not  have  pain-relieving  potency,  but  is  as  effective  as  codeine  for  the  relief 
of  cough.  It  will  not  support  an  established  dependence  of  morphine-type  but 
the  sul)jective  effects  of  large  doses,  mainly  psychotomimetic  rather  than  mor- 
phine-like, are  appreciated  by  some  subjects  and  a  few  cases  of  abuse  have 
been  encountered.  Preparations  of  dextromethorphan  are  available  over  the 
counter. 

Phenazocine  (Prinadol®,  Narphen®)  is  a  result  of  further  simplification  of  the 
morphine  molecvile,  or  of  less-advanced  synthesis  toward  the  morphine  molecule. 
It  is  a  basic  structure  present  in  morphine  and  levorphanol  and  represents  fur- 
ther deletion  of  certain  chemical  features.  It  is  qualitatively  similar  to  morphine 
in  its  action  but  shows  some  quantitative  differences.  Analgesic  potency  is  pres- 
ent in  phenazocine  about  on  a  par  with  that  of  levorphanol,  that  is,  several  times 
greater  than  with  morphine.  Side  effects  are  similar  with  all  three  drugs.  De- 
pendence capacity  is  reduced  definitely,  as  measured  by  animal  experiments, 
but  little  as  judged  by  quantitative  comparisons  in  man.  Phenazocine  is  effective 
orally,  often  nearly  as  effective  as  after  parenteral  injection,  and  therein  may  lie 
its  greatest  u.sefulness.  Oral  phenazocine  has  been  well  received  in  England' and 
other  countries :  it  has  not  been  marketed  for  oral  use  in  the  United  States. 

Propoxyphene  (Darvon®)  is  structurally  related  to  methadone  and  has  en- 
joyed wide  popularity  as  a  mild  oral  analgesic,  especially  ia  combination  with 
APC  (aspirin,  phenacetin,  and  caffeine).  An  intensive  review  of  manv  studies, 
comparing  the  drug  w^ith  codeine,  or  with  aspirin,  or  APC,  concluded  that  even 
the  mixture  with  APC  hardly  equaled  the  oral  effectiveness  of  codeine  and 
certainly  did  not  surpass  it.  Propoxyphine  can  produce  morphine-like  subjective 
effects,  supports  an  established  morphine  dependence  poorly,  but  has  measurable 
dependence-producing  capacity.  Cases  of  abuse  have  been  reported.  However, 
after  5  years  of  marketing  experience,  the  abuse  liability  of  propoxyphene  as  a 

60-296— 71— pt.  1 i 


42 

public  health  hazard  was  judged  not  to  warrant  narcotics  control,  nationally  or 
internationally. 

Caramiphen  (Parpanit®)  is  not  related  chemically  to  any  of  the  compounds 
which  have  been  described.  It  was  introduced  as  a  relaxant  and  later  shown 
to  have  cough-suppressant  action,  but  there  have  been  few  controlled  studies 
comparing  it  with  codeine.  Few  side  effects  have  been  reported  and  no  case  of 
dependence  or  abuse. 

Benzonatate  (Tessalon®)  is  also  unrelated  to  the  morphine  structure,  but  is 
claimed  to  have  a  suppressant  effect  on  cough  reflexes  both  at  the  site  of  irrita- 
tion peripherally  and  at  the  responding  center  in  the  nervous  .system.  Again 
there  have  been  few  carefully  controlled  .studies.  The  recommended  therapeutic 
dose  is  at  least  three  times  larger  than  for  codeine  and  tolerance  to  the  cough- 
relieving  action  may  occur. 

Pentazocine  (Talwin®)  is  a  member  of  the  benzomorphan  series  of  which 
phenazocine  was  the  first  marketed  example,  and  illustrates  our  most  promising 
leads  for  opiate  substitution.  These  constitute  two  underlying  basic  principles : 
(1)  Animal  experiments  have  shown  consistently  greater  dissociation  of  pain 
relief  and  dependence  capacity  among  the  benzomorphans,  which  represent  only 
partial  synthesis  toward  morphine,  than  in  any  other  chemical  group.  This 
ti'end  has  been  partially  confirmed  in  studies  in  man;  (2)  Whether  the  basic 
structure  is  morphine,  morphinan,  or  benzomorphan,  certain  modifications  have 
led  to  the  appearance  of  specific  antagonistic  properties  simultaneously  with 
the  retention  of  some  morphine-like  action.  Compounds  displaying  such  a  com- 
bination of  effects  are  classified  as  agonist-antagonists  and  pentazocine  is  in 
this  group.  It  relieves  pain  satisfactorily,  given  orally  or  parenteral] y  at  a  dose 
about  four  times  greater  than  for  morphine.  Side  effects  with  therapeutic  doses 
are  morphine-like.  Pentazocine  is  also  a  weak  morphine  antagonist  and  will  not 
support  an  established  morphine  dependence.  Chronic  administration  of  pentazo- 
cine causes  the  appearance  of  some  dependence  and  a  mild  abstinence  syndrome 
when  the  drug  is  abruptly  withdrawn.  Both  the  dependence  and  the  abstinence 
syndrome  are  partly  like,  partly  unlike,  these  phenomena  with  morphine.  There 
is  less  drug-seeking  behavior.  The  clinical  effectiveness  of  pentazocine  is  being 
well  received  by  physicians  and  patients.  A  few  cases  of  abuse  have  been  re- 
ported, very  few  in  relation  to  the  total  doses  prescribed.  The  drug  has  not 
been  subjected  to  narcotics  control. 

The  foregoing  descriptions  confirm,  I  think,  that  we  can  do  without  morphine 
and  codeine  but  the  book  on  opiate  substitution  is  not  closed.  Not  only  is  the 
agonist-antagonist  group  undergoing  and  worthy  of  much  further  study,  but 
there  are  other  compounds  of  diverse  structure  in  development,  following  fur- 
ther dissociation  of  dependence  capacity  and  therapeutic  action. 

[Exhibit  No.  4(b)] 

Curriculum  Vitae  of  Dr.  Nathan  Browne  Eddy,  Chairman,  Committee  of 
Problems  of  Drug  Dependence,  Division  of  Medical  Sciences,  National 
Academy  of  Sciences-National  Research  Council 

Date  and  place  of  birth  :  Glens  Falls,  N.Y,  August  4, 1890. 

Family:  Wilhelmina  Marie  Aherns    (wife);  Charles  Ernest  Edjdy    (son),   de- 
ceased. 
Education  and  degrees  :  1911 — Cornell  University  Medical  School — M.D. :  1963 — 

University  of  Michigan — D.  Sc.  (honorary). 
Special  training  or  experience : 

1911-16 — Practice  of  medicine.  New  York  City. 

1916-20 — Instructor  of  physiology,  McGill  University  ;  teaching  and  research. 

1926-28 — Assistant    professor,    physiology    and    pharmacology,    T^niversity 

of  Alberta — teaching  and  research. 
1928-30 — Associate  professor  of  pharmacology,  University  of  Alberta,  teach- 
ing and  Research. 

1927  (May-September)  Visiting  investigator.  Department  of  Pharmacology, 
Cornell  University  Medical  School. 

1928  (May-September)   Visiting  investigator  and  lecturer.  Department  of 
Physiology,  University  of  Michigan  Medical  School. 

1929  (May-September.)   Visiting  investigator  and  lecturer,  Department  of 
Physiology,  University  of  Michigan  Medical  School. 


43 

1930-39 — Research  professor  in  pharmacology,  University  of  Michigan — 
rGSGcircli. 

1980-39 — Consultant  Biologist  in  Alkaloids,  U.S.  Public  Health  Service. 

1939-49 — Princii)al  Pharmacologist,  National  Institutes  of  Health. 

1949-60 — Medical  Officer,  General,  National  Institutes  of  Health. 

1951-60 — Chief,  Section  on  Analgesics,  Laboratory  of  Chemistry.  National 
Institute  of  Arthritis  and  Metabolic  Diseases,  National  Institutes  of  Health 
—retired  August  31, 1960. 

1960 — Consultant  on  Narcotics,  National  Institutes  of  Health. 

1961-67 — Professional  Associate,  designated  Executive  Secretary,  Com- 
mittee on  Drug  Addiction  and  narcotics,  Medical  Division,  National  Re- 
search council. 

1968 Consultant,  Bureau  of  Narcotics  and  Dangerous  Drugs. 

1969 Consultant  New  York  State  Narcotic  Addiction  Control  Commission. 

1970 Consultant  Le  Dain  Commission  on  Nonmedical  Use  of  Drugs. 

Membership  in  professional  organizations : 

Society  of  Pharmacology  and  Experimental  Therapeutics. 

American  Association  for  the  Advancement  of  Science. 

Society  for  Experimental  Biologyand  Medicine. 

Sigma  Xi. 

Editorial  board,  Excerpta  Medica ;  editorial  advisory  board  "Voice  of 
America". 

Society  for  the  study  of  addiction  to  alcohol  and  other  drugs. 

Washington  Academy  of  Sciences. 

American  College  of  Clinical  Pharmacology  and  Chemotherapy. 

Institute  for  the  Study  of  Addiction. 

College  of  Neuropsychopharmacology. 

Eastern  Psychiatric  Research  Association. 
Committee  appointments,  etc. : 

Committee  on  Drug  Addiction  and  Narcotics  (Problems  of  Drug  Depend- 
ence), National  Research  Council,  Secretary  1947-61;  chairman  1970. 

U.S.  Public  Health  Service  Drug  Addiction  Committee  (resigned). 

U.S.  Public  Health  Service  Post  Office  Advisory  Committee,  (resigned). 

Bureau  of  Narcotics  Advisory  Committee  on  Oral  Prescription  bill.  Ad  hoc. 

Advisory  Committee  under  Narcotics  Manufacturing  Act  of  1960. 
Chairman,  1961. 

Expert  Panel  on  Addiction-Producing  Drugs,  World  Health  Organization ; 
member  of  each  expert  committee  chosen  from  this  panel ;  chairman  of 
Committee  on  first,  second,  eighth,  ninth,  12th,  13th,  and  16th  sessions. 

Technical  Adviser,  U.S.  Delegation  to  United  Nations  Commission  on  Nar- 
cotic Drugs.  1947,  1948,  1957,  and  1958. 

Technical  Committee,  United  Nations  Plenipotentiary  Conference  on  Single 
Convention  on  Narcotics  Control,  1961. 

Special  Consultant  to  Addiction-Producing  Drugs  Section,  World  Health 
Organization,  1954, 1955, 1956, 1959,  and  1961. 

Consultant  to  Army  Chemical  Center. 

American  Social  Health  Association  Advisory  Committee  on  Narcotic  Addic- 
tion. 

Delegate  and  Panelist,  Wliite  House  Conference  on  Narcotic  and  Drug  Abuse, 
September  27-28, 1962. 

Alternate   delegate   for   ASHA    National    Coordinating   Council    on   Drug 
Abuse  Information  and  Education. 
Honors  and  Awards : 

Corecipient,  First  Annual  Scientific  Award,  American  Pharmaceutical 
Manufacturers  Association,  1939. 

Guest  speaker,  Royal  Canadian  Institute,  Toronto  Ontario,  Canada,  March 
28, 1953. 

Lister  Memorial  Lecture,  October  1,  1959,  Edinburgh,  Scotland. 

Public  Health  Service  Superior  Performance  Award  for  Sustained  Outstand- 
ing Service,  August  31,  1960. 

Delegate  and  gue.st  speaker,  Los  Angeles  Conference  on  Narcotic  and  Drug 
Abuse,  April  27-28, 1963. 

Guest  speaker,  Hawaiian  Pharmaceutical  Association,  Honolulu,  May  4, 1963. 

D.  Sc  (honorary)  University  of  Michigan,  1963. 

Dent  Lecturer,  Society  for  the  Study  of  Addiction,  London,  1967. 

WHO  Medal  for  Distinguished  Service,  1969. 

Snow  Medal  of  American  Social  Health  Association,  1969. 

Gold  Medal  of  Eastern  Psychiatric  Research  Association,  1970. 


44 


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(2 


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the  circulating  blood."  Am.  J.  Physiol.,  51 :  279-288, 1920. 

"Effect  of  subcutaneous  injections  of  thymus  substance  in  young 


rabbits."  Endocriu.,  4  :  420-428,  1920. 

"Extensibility  of  muscle :  The  effect  of  stretching  upon  the  develop- 


ment of  fatigue  in  a  muscle."  Am.  J.  Physiol.,  56 :  182-187,  1921. 

"Extensibility  of  muscle:  The  production  of  carbon  dioxide  by  a 


muscle  when  it  is  made  to  support  a  weight."  Am.  J.  Physiol..  56 :  188- 

195,  1921. 
Nathan  B.  Eddy.  "The  internal  secretion  of  the  spleen."  Endocrinologv. 

5 :  461-475,  1921. 
"A  simple  device  for   the  demonstration   of  heart   block   in   the 

student  laboratory."  J.  Lab.  and  Clin.  Med.,  6 :  635-638, 1921. 
Ardrey  W.  Downs  and  Nathan  B.  Eddy.  "Secretin.    V.  Its  effect  in  anae- 
mia with  a  note  on  the  supposed  similarity  between  secretin  and  vitamin 

B."  Am.  J.  Physiol.,  58  :  296-300, 1921. 
"Further  observations  on  the  effect  of  the  subcutaneous  injection 

of  spenic  extract."  Am.  J.  Physiol.,  62  :  242-247, 1922. 

"Some  unusual  appearances  of  nucleated  erythrocytes  in  the  cir- 


culation following  repeated  injection  of  splenic  extract."  Am.  J.  Phvsiol.. 
63 :  479-483,  1923. 

"Secretin  and  a  suggestion  as  to  its  therapeutic  value."  Endocrin- 


ology, 7 :  713-719,  1923. 
Nathan  B.   Eddy.   "The  action  of  preparations  of  the  endocrine  glands 

upon  the  work  done  by  skeletal  muscle."  Am.  J.  Phvsiol.,  69 :  430-440, 

1924. 
Ardrey  W.  Downs  and  Nathan  B.  Eddy.  "Secretin  :  VI.  Its  influence  on 

the  antibodies  of  the  blood."  Agglutinin.  Am.  J.  Physiol.,  77 :  40-43,  1924. 
Ardrey    W.  Downs,  Nathan  B.  Eddy,  and  Robert  M.  Shaw.  "Secretin : 

VII.  Its  inflence  on  the  antibodies  of  the  blood."  Complement.  Am.  J. 

Physiol.,  71  :  44-45,  1924. 
"Secretin:  VIII.  Its  influence  on  antibodies  of  the  blood:  Haemolv- 


tic  amboceptor."  Am.  J.  Physiol.,  71 :  46-48. 1924. 
Nathan  B.  Eddy  and  Ardrey'  W.  Downs.  "Blood  regeneration."  Canadian 

Med.  Assn.  J.,  16  :  391-396,  1926. 
"Secretin :  IX.  Its  relation  to  the  activity  of  skeletal  muscle."  Am. 

J.  Physiol.,  7.^ :  489-490,  1925. 
Nathan  B.   Eddy.  Studies  on  hypnotics  of  the  barbituric  acid  series." 

J.  Pharmacol,  and  Exper.  Therap..  33  :  43-68.  1928. 
Nathan  B.  Eddy  and  Ardrey  W.  Downs.  "Tolerance  and  cross-tolerance 

in  the  human  subject  to  the  diuretic  effect  of  carreiue.  theobromine. 

and  theophylline."  J.  Pharmacol.  &  Exper.  Therap.,  33:  167-174.  T92S. 


45 

(28)  Nathan  B.  Eddy  and  Robert  A.  Hatcher.  "The  seat  of  the  emetic  action 

of  the  digitalis  bodies."  J.  Pharmacol,  and  Exper.  therap.,  33 :  295-300, 
1928. 

(29)  Ardrey  W.  Downs  and  Nathan  B.  Eddy.  "Morphine  tolerance:  I.  The 
acquirement,  existence  and  loss  of  tolerance  in  dogs."  J.  Lab.  and  Clin. 

Med.,  13  :  739-745.  1928. 

(30)   "Morphine  tolerance:  II.  The  susceptability  of  morphine  tolerant 

dogs  to  codeine,  heroin  and  scopolamine."  J.  Lab  and  Clin.  Med.,  13 : 
745-749,  1928. 

(31)  Ardrey  W.  Downs,  Nathan  B.  Eddy,  and  John  P.  Quigley.  "Morphine 

tolerance :  III.  The  effect  of  cocaine  upon  dogs  before,  during  and  after 
habituation  to  morphine."  J.  Lab.  and  Clin.  Med..  13 :  839-842,  1928. 

(32)  Nathan  B.  Eddy.  "The  regulation  of  respiration:  XXVII.  Tlie  effect  upon 

salivary  secretion  of  varying  the  carbon  dioxide  and  oxygen  content  of 
of  the  inspired  air."  Am.  J.  Physiol.,  88:  534-545,  1929. 

(33)  "The  effect  of  the  repeated  administration  or  diethyl  barbituric 

acid  and  of  cyclohexenylethyl  barbituric  acid."  J.  Pharmacol.  &  Exper. 
Therap.,  37:  261-271,  1929. 

(34)   "The  excretion  of  diethyl  barbituric  acid  during  its  continued  ad- 
ministration." J.  Pharmacol.  &  Exper.  Therap.  37;  273-282,  1929. 

(35)  Ardrey  W.  Downs  and  Nathan  B.  Eddy.  "The  influence  of  Tyramine  on 

the  number  of  red  corpuscles  in  the  circulating  blood."  Proc.  Soc.  Exper. 
Biol.  &  Med.,  27:  405-407, 1930. 

(36)  Nathan  B.  Eddy.  "Antagonism  between  methylene  blue  and  sodium  cya- 

nide." J.  Pharmacol.  &  Exper.  Therap.,  39:  271,  1930.  (Proc.) 

(37)  "Regulation  of  respiration.  The  effect  upon  salivary  secretion  of 

the  intravenous  administration  of  sodium  bicarbonate,  sodium  carbon- 
ate, sodium  hydroxide,  sodium  chloride,  and  sodium  sulphate."  Quart. 
J.  Exper.  Physiol.,  20:  313-320,  1930  (8  plates). 

(38)  "Regulation  of  respiration.  The  effect  upon  salivary  secretion  of 

the  intravenous  administration  of  lactic  acid,  sodium  lactate,  and  hydro- 
chloric acid."  Quart.  J.  Exper.  Physiol.,  20:  321-326.  1930  (5  plates). 

(39)   —"Regulation  of  respiration.  The  effect  upon  salivary  secretion  of 

the  intravenous  administration  of  ammonium  chloride  and  ammonium 
carbonate."  Quart.  J.  Exper.  Physiol.,  20:  327-332,  1930  (5  plates). 

(40)  "Regulation  of  respiration.  The  effect  upon  salivary  secretion  of 

an  increased  oxygen  content  of  the  inspired  air  and  of  forced  venti- 
lation." J.  Pharmacol.  &  Exper.  Therap.,  4I:  42.3-433,  1931. 

(41)  "Regulation  of  respiration.  The  effect  upon  salivary  secretion  of 

the  intravenous  administration  of  sodium  sulphide,  sodium  cyanide  and 
methylene  blue."  J.  Pharmacol.  &  Exper.  Therap..  4I:  435-447,  1931. 

(42)   "Regulation    of   respiration.   The  antagonism   between   methylene 

blue  an  dsodium  cyanide."  J.  Pharmacol.  &  Exper.  Therap.,  4i-'  449-464, 
1931. 

(43)  "The  action  of  the  codine  isomers  and  some  of  their  derivatives." 

J.  Pharmacol.  &  Exper.  Therap.,  45:  236,  1932.  (Proc.) 

(44)  "A  comparison  of  phenanthrene  and  some  2-,  3-,  and  9-monosubsti- 

tution  products."  J.  Pharmacol.  &  Exper.  Therap.,  45:  257,  1932.  (Proc.) 

(45)  Nathan  B.  Eddy  and  A.  Kenneth  Simon.  "The  measurement  of  the  de- 

pressant action  of  the  codeine  isomers  and  related  substances  by  the 
use  of  mazetrained  rats."  J.  Pharmacol.  &  Exper.  Therap.,  45:  — ,  1932. 
(Proc.) 

(46)  Hugo  M.  Kreugar  and  Nathan  B.  Eddy.  "A  study  of  the  effects  of  codeine 

and  isomers  on  the  movements  of  the  small  intestine."  J.  Pharmacol.  & 
Exper.  Therap.,  45: 266, 1932.  (Proc.) 

(47)  Nathan  B.  Eddy.  "Studies  of  morphine,  codeine,  and  their  derivatives: 

I.  General  Methods."  J.  Pharmacol.  &  Exper.  Therap.,  45:  339-359,  1932. 

(48)  "Studies  of  morphine,  codeine,  and  their  derivatives:  II.  Isomers 

of  codine."  J.  Pharmacol.  &  Exper.  Therap.,  45:  361-381,  1932. 

(49)  Ardrey  W.  Downs  and  Nathan   B.  Eddy.   "Influence  of  barbital  upon 

cocaine  poisoning  in  the  rat."  J.  Pharmacol.  &  Exper.  Therap.,  45:  383- 
387,  1932. 

(50)  "Effect  of  repeated  doses  of  cocaine  on  the  dog."  J.  Pharmacol.  & 

Exper.  Therap.,  46: 195-198,  1932. 

(51)  "Effect  of  repeated  doses  of  cocaine  on  the  rat."  J    Pharmacol.  & 

Exper.  Therap.,  46:  299-200,  1932. 


46 

(52)  Nathan  B.  Eddy.  "Dilaudid."  J.  Am.  Med.  Assn.,  100:  1031-1035,  1933. 

(53)  Gerald  G.  Woods  and  Nathan  B.  Eddy.  "Some  new  alkamines  of  the 

tetrahydronapthalene  series."  J.  Pharmacol.  &  Exper.  Therap.,  48:  175- 
181,  1933. 

(54)  Nathan  B.  Eddy.  "Studies  of  phenanthrene  derivatives :  I.  A  comparison 

of  phenanthrene  and  some  2-,  3-,  and  9-monosubstitution  products."  J. 
Pharmacol.  &  Exper.  Therap.,  48: 183-198, 1933. 

(55)  "Studies  of  the  relation  of  the  hydroxyl  groups  of  morphine  to  its? 

pharmacological  action."  J.  Pharmacol.  &  Exper.  Therap.,  48 :  271,  1983. 
(Proc.) 

(56)  "Studies  of  morphine,  codeine,  and  their  derivatives :  III.  Morphine 

methochloride  and  codeine  methocloride."  J.  Pharmacol.  &  Exper. 
Therap,.  49:  319-327, 1933. 

(57)  "Studies  of  morphine,  codeine,  and  their  derivatives:  IV.  Hydro- 

genated  codine  isomers."  J.  Pharmacol.  &  Exper.  Therap.,  51:  35-4:4, 
1934. 

(58)  "Studies  of  phenanthrene  derivatives:  II.  Monosubstitution  prod- 
ucts, first  variations.  The  effect  of  muzzling  the  hydroxyl  group  of  2-  or 
3-hydroxyphenanthrene."  J.  Pharmacol.  &  Exper.  Therap.,  51:  75-84, 
1934. 

(59)  Charles  W.  Edmunds  and  Nathan  B.  Eddy.  "Some  studies  on  the  drug 

addiction  problem."  Michigan  Alumnus  Quarterly  Review,  4^:  250-257, 
1934. 

(60)  Charles  W.  Edmunds,  Nathan  B.  Eddy,  and  Lyndon  P.  Small.  "Studies 

on  morphine  addition  problem."  J.  Am.  Med.  Assn..  103:  1417,  1934. 

(61)  Nathan  B.  Eddy.  "Studies  of  phenanthrene  derivatives:  III.  Di-subst. 
'f>=  products."  J.  Pharmacol.  &  Exper.  Therap.,  52 :  275-289,  1934. 

(62)  Nathan  B.  Eddy  and  John  G.  Reid.  "Studies  of  morphine,  codeine,  and 

their  derivatives:  VII,  Dihydromorpliine  (paramorphan),  dihydro- 
morphinene,  (Dilaudid),  and  dihydrocodeinone  (Dicodide)."  J. 
Pharmacol.  &  Exper.  52  :  468-493, 1934. 

(63)  Nathan  B.  Eddy  and  Homer  A.  Howes.  "Studies  of  morphine,  codeine, 

and  their  derivatives :  VIII.  Monoacetyl-  and  diacetylmorphine  and 
their  hydr.  derivatives."  J.  Pharmacol.  &  Exper.  Therap.,  53:  430-439, 
1935. 

(64)  Nathan  B.  Eddy.  "Phenanthrene  studies.  The  effect  of  different  nitric- 

taining  side-chains."  J.  Pharmacol.  &  Exper.  Therap.,  54 :  149,  1935. 

(65)  A.  Kenneth  Simon  and  Nathan  B.  Eddy.  "Studies  of  morphine,  codeine, 

and  their  derivatives  :  V.  The  use  of  maze-trained  rats  to  study  the  effect 
on  central  nervous  system  of  morphine  and  related  substances."  Am.  J. 
^7 :  597-613,  1935. 

(66)  Nathan  B.  Eddy  and  Bertha  Aheens.  "Studies  of  morphine,  codeine,  and 

their  derivatives :  VI.  The  measurement  of  the  central  effect  of  codeine, 
hydrocodeine,  and  their  isomers  bv  the  use  of  maze-trained  rats."  Psy- 
chol., ^7 :  614-623, 1935. 

(67)  Nathan  B.  Eddy.  "Studies  of  morphine,  codeine,  and  their  derivatives: 

Methyl  ethers  of  the  morphine  and  codeine  series."  J.  Pharmacol.  & 
Therap.,  55  :  127-135. 1935. 

(68)  Nathan  B.  Eddy  and  Homer  A.  Howes.  "Studies  of  morphine,  codeine, 

and  their  derivatives :  X.  Desoxymorphine-C,  desoxycodeine-C  and  their 
hydro  derivatives."  J.  Pharmacol.  &  Exper.  Therap.,  55 :  257-267,  1935. 

(69)  Natpian  B.  Eddy.  "Studies  of  phenanthrene  derivatives:  V.  Homologous 

and  aldehvdes  and  some  of  their  derivatives."  J.  Pharmacol.  &  Exper. 
Therap.,  55  :  354-364, 1935. 

(70)  "Studies  of  phenanthrene  derivatives :  VI.  Amino  alee  of  the  ethan- 

olamine  and  propanolamine  type."  J.  Pharmacol.  &  Exper.  55 :  419-429, 
1935. 

(71)  "Studies  of  morphine,  codeine,  and  their  derivatives:  The  isomers 

of  morphine  and  dihydromorphine."  J.  Pharmacol.  «&  Exper.  56' :  429-431, 
1936. 

(72)  "Studies  of  phenanthrene  derivatives:  'SMI.  A  comparing  analogous 

phenanthrene  and  dibenzofurau  derivatives."  J.  Pharmacol.  Exper. 
Therap.,  58  :  159-170, 1936. 

(73) ^"Drug  Addiction.  Pharmacological  Studies."  Hosp.  New  34,  1936. 


47 

(74)  Nathan  B.  Eduy  and  C.  K.  Himmelsbach.  "Experiments  on  the  tolerance- 

and  addiction  potentialities  of  dihydrodesoxymorphiue-D  ("Desomor- 
phine")."  Suppl.  No.  118  to  the  U.S.  Public  Health  Reports.  33  pp..  1936. 

(75)  Nathan  B.  Eddy.   "Analgesic  and  other  effects  of  some  carbazoles."  J. 

Pharmacol.  &  Exper.  Therap.,  60:  105,  1937  (Proc.) 

(76)   "The  search  for  more  effective  morphine-like  substitutes."  Am.  J. 

Med.  Sc,  J97  :  464^79, 1939. 

(77)  Lyndon  F.  Small,  Nathan  B.  Eddy,  Erich  Mosettig,  and  C.  K.  Himmels- 

bach. "Studies  on  drug  addiction.  With  special  reference  to  chemical 
structure  of  opium  derivatives  and  allied  synthetic  substances  and  their 
physiological  action."  Suppl.  No.  138  to  U.S.  Public  Health  Reports,  143 
pp.,  1939. 

(78)  Nathan  B.  Eddy.  "Studies  of  carbazole  derivatives:  I.  Amino-carbazoles." 

J.  Pharmacol.  &  Exper.  Therap.,  65  :  294-307, 1939. 
(79) "Studies  of  carbazole  derivatives:  II.  Amino  alcohols  and  deriva- 
tives of  tetrahydrocarbazole."  J.  Phai-macol.  &  Exper.  Therap.,  65 :  308- 
317,  1939. 

(80)  "Studies  of  morphine,  codeine,  and  their  derivatives:  XIV.  The 

variation  with  age  in  the  toxic  effects  of  morphine,  codeine,  and  some 
of  their  derivatives."  J.  Pharmacol.  &  Exper.  Therap..  66 :  182-201,  1939. 

(81)  Nathan  B.  Eddy  and  Margaret  Sumwalt.  "Studies  of  morphine,  codiene, 

and  their  derivatives :  XV  2,4-Dinitrophenylmorphine."  J.  Pharmacol, 
&  Exper.  Therap.,  67  :  127-141,  1939. 

(82)  Nathan  B.  Eddy.  "Pharmaceutical  education  and  the  public  health."  Am. 

J.  Pharmaceut.  Ed.,  181-186, 1942. 

(83)  Hugo  Krueger,  Nathan  B.  Eddy,  and  Margaret  Sumw^alt.  "The  Pharma- 

cology of  the  Opium  Alkaloids."  Suppl.  No.  165  to  the  Public  Health 
Reports,  1448  CXL  pp.,  1943. 

(84)  Nathan  B.  Eddy.  "4,4-Diphenyl-6-dimethylamino-heptanone-3 :  A  new  syn- 

thetic morphine-like  analgesic."  Soc.  for  Exper.  Biol.  &  Med.,  Washing- 
ton Section,  April  1947. 

(85)  "Metopon  hydrochloride."  J.  Am.  Med.  Assn.,  134:  219-292,  1947. 

(86)  Harris  Isbell,  Abraham  Wikler,  Nathan  B.  Eddy,  John  L.  Wilson,  and 

Clifford  F.  Moran.  "Tolerance  and  addiction  liability  of  4,4-diphenyl- 
6-dimethylamino-heptanone-3  (Methadone)."  J.  Am.  Med.  Assn.,  135: 
883-894,  1947. 

(87)  Nathan  B.  Eddy.  "Metopon."  J.  Am.  Pharmaceut.  Assn.,  Pract.  Pharmac. 

Education,  8  :  430-433, 1947. 

(88)   "A  new  morphine-like   analgesic."   J.    Am.   Pharm.   Assn.,   Pract. 

Pharm.  Ed..  8  :  536-540, 1947. 

(89)  "Analgesic  drugs  in  cancer  therapy."  Fourth  International  Cancer 

Research  Congress,  St.  Louis,  Sept.  5,  1947.  Acta  L'Union  luteruat. 
Cong.  Cancer,  6  :  1379-1385, 1950. 

(90)  "Metopon."  Am.  Soc.  Anesthesiologists — Symposium  on  New  Drugs, 

New  York,  Dec.  5,  1947. 

(91)  "Progress  in  Drug  Therapy  of  Pain."  Am.   Pharmaceut.   Monuf. 

Assn.,  Annual  Award  Meeting,  New  York,  Dec.  16,  1947.  Am.  Prof. 
Pharmacist,  14  :  252-253, 1948. 

(92)  "Metopon   hydrochloride."   Canad.   Med.   Assn.   J.    January   1947. 

(93)  "Metopon  hydrochloride  (Methyldihydromorphinone  hydrochlo- 
ride)." Report  to  the  Council  on  Pharmacy  and  Chemistry  of  the  AMA 
by  the  Committee  on  Drug  Addiction  and  Narcotics  of  the  National  Re- 
search Council.  J.  Am.  Med.  Assn.,  137  :  365-367, 1948. 

(94)  "Newer  analgesics  in  the  control  of  pain  in  cancer  patients."  Post- 
graduate symposium  on  Cancer,  Medical  College  of  Virginia,  Rich- 
mond, Va.  Mar.  25, 1948.  Unpublished. 

(95)  "Newer  preparations  for  pain  relief."  Read  Apr.  16,  1948.  George 

Washington  University  Medical  School.  Postgraduate  course.  Unpub- 
lished. 

(96)  "Progress  in  drug  therapy  of  pain."  Adapted  from  No.  91.  Read 

at  Staff  Meeting  of  Arlington  Hospital,  Arlington,  Va.  May  6.  1948. 
Unpublished. 

(97)  "Pharmacology  of  Metopon  and  other  new  analgesic  opium  deriva- 
tives." New  York  Academy  of  Science.  May  14-15,  1948.  Ann.  N.Y. 
Acad.  Science,  51 :  51-58, 1949. 


48 

(98)  "The  New  Narcotics,  Post-graduate  Course  in  Internal  Medicine 

of  tlie  American  College  of  Physicians,  May  22,  1948."  Am.  Practitioner, 
3  :  37^2,  1948. 

(99)   "Cooperation  on  Narcotics."  Drug  &  Allied  Indust.,  5:  8-11,  1949. 

(100) .  "Metopon  hydrochloride.  An  Experiment  in  Clinical  evaluation." 

U.S.  Public  Health  Reports,  64  :  93-103,  1949. 

(101)  - — —"Progress  in  drug  therapy  of  pain."  Am.  Professional  Pharmacists, 

14 :  2.52,  1948. 

(102)  "The  relation  of  chemical  structure  to  analgesic  action."  J.  Am. 

Pharmaceut.  Assn.,  Sc.  Ed.,  39  :  24.5-251, 1950. 

(103)  Nathan   B.    Eddy,   Caroline    Fuhrmeister  Touchberrt,  and  Jacob   E. 

LiEBERMAN.  "Synthetic  analgesics.  I.  Methadone  isomers  and  deriva- 
tives." J.  Pharmacol.  &  Exper.  Therap.,  98  :  121-137, 19.50. 

(104)  Nathan  B.  Eddy.  "Methadols  and  acetylmethadols."  Read  Lilly  Research 

Laboratories,  May  24,  1951 :  Pharmacological  Institute,  Basle,  Switzer- 
land, Nov.  15,  1951.  Unpubli.shed. 

(105)  Nathan  B.  Eddy,  Evekette  L.  May,  and  Erich  Mosettig.  "Chemistry  and 

pharmacologv  of  the  methadols  and  acetylmethadols :  XII."  Interna- 
tional Cong.  Chem.,  New  York,  Sept.  7,  1951 :  J.  Org.  Chem.,  17 :  321-326. 
1952. 

(106)  Nathan  B.  Eddy.  "N-Allylnormorphine."  Comm.  Drug  Addiction  &  Nar- 

cotics. Jan.  21, 1952.  Unpublished. 

(107)  "Drugs  liable  to  produce  addiction  (The  work  of  the  World  Health 

Organization  Expert  Committees)."  Public  Health  Reports,  61:  362, 
1952. 

(108)  Nathan  B.  Eddy  and  Everette  L.  May.  "The  isomethadols  and  their  acetyl 

derivatives."  J.  Org.  Chem.,  17  :  210-215, 1952. 

(109)  Nathan   B.   Eddy,   G.   Robert  Coatney,  W.   Clark  Cooper  and  Joseph 

Greenberg.  "Survey  of  antimalarial  agents."  Public  Health  Monograph, 
No.  9  :  .323  pp.  U.S.  Govt.  Print.  Off.,  Washington.  D.C.  1953. 

(110)  Nathan  B.  Eddy  and  Dorothy  Leimbach.  "Synthetic  Analgesics:  II.  Di- 

thienvlbutenyl-  and  dithienylbutylamines."  J.  Pharmacol.  &  Exper. 
Therap.  107 :  385-393,  19.53. 

(111)  Nathan    B.    Eddy.    "Heroin    (diacetylmorphine).    Laboratory   &   clinical 

evaluations  of  its  effectiveness  and  addiction  liability."  Bull.  Narcotics, 
5:39-44,1953. 

(112)   "Symposium  on  drug  addiction:  Foreword."  Am.  J.  Med.  14'-  537, 

1953. 

(113)  —  "The  hot  plate  method  for  measuring  analgesic  effect  in  mice."  Na- 
tional Research  Council  Bull.  Drug  Addiction  &  Narcotics,  603-612, 
19.53.  Unpublished. 

(114)   "Drug   Addiction:    Fact   and    Fancy."   Royal   Canadian   Institute, 

Toronto.  Canada,  Mar.  28,  19.53.  Pro.  Roval  Canad.  Inst.,  18:  44,  19.53: 
Health  Ed.  J.,  17  :  1,  11 ;  17  :  2. 14-19,  19.53. 

(115)  Dorothy   Leimbach   and  Nathan   B.   Eddy.   "Synthetic  analgesics:   III. 

Methadols,  Isomethadols  and  their  acvl  derivatives."  J.  Pharmacol.  & 
Exper.  Therap.,  110  :  135-147,  19.54. 

(116)  Nathan  B.  Eddy.  "The  Phenomena  of  tolerance."  Symposium  on  Drug 

Resistance,  Washington,  D.C,  Mar.  26,  1954.  Published  by  Academic 
Press — "Origins  of  Resistance  to  Toxic  Agents."  pp.  22.3-243*  1955. 

(117)   "The  Committee  on  Drug  Addiction  and  Narcotics."  News  Report, 

National  Academy  of  Sciences  ;  ^  :  93, 1954. 

(118)  Olav  J.  Braenden,  Nathan  B.  Eddy,  and  H.  Halbach.  "Synthetic  sub- 

stances with  morphine-like  effect.  Relationship  between  chemical  struc- 
ture and  analgesic  action."  Bull.  World  Health  Organization,  13:  937, 
19.55. 

(119)  Nathan  B.   Eddy.   "Addiction  liability  of  nlagesics:  tests  and  results." 

Read,  Symposium  on  alagesics,  American  Theraueptic  Society,  June  3, 
19.55,  Atlantic  City,  N.J.  J.  Am.  Geriatrics  Society,  4: 177,  19-56. 

(120)   "The  search  for  new  analgesics.  Part  of  Symposium,  Pain  and  its 

relief."  J.  Chronic  Dis.,  //.-  59, 1956. 

(121)  Nathan  B.  Eddy,  II.  Haibach,  and  Olav  J.  Brafndex.  "Synthetic  sub- 

stances with  morphine-like  effect.  Relationship  between  analgesic  action 
and  addiction  liability,  with  a  discussion  of  the  chemical  structure  of 
addiction  producing  substances."  Bull.  World  Health  Organization,  14: 
.353.  1956. 


49 

(122)  Nathan  B.  Eddy.  "Synthetic  narcotic  drugs."  Union  Signal,  82:  7,  19r.5. 

(123)  Theodore  D.  Perrine  and  Nathan  B.  Eddy.  '"The  preparation  and  anal- 

gesic activity  of  4-carbethoxy-4-pheuyl-l-(2-phenyIetliyl) -piper idine  and 
related  compounds."  J.  Org.  Cheni.,  21: 12.j,  ID.jH. 

(124)  Nathan  B.  Eddy.   "Habit-forming  drugs."  Bull.  Drug  Addiction  &  Nar- 

cotics, p.  1494.  195«;. 

(125)  "The  history  of  the  development  of  narcotics."  Law  and  Contempo- 
rary Problems,  22:  3,  1907. 

(12G)  "Addiction-producing  versus  habit-forming."  Guest  editorial  J.  Am. 

Med.  Assn.,  163:  1G22,  1957. 

(127)  "New  developments  in  analgesics."  Read,  Bahamas  Medical  Con- 
ference, Nassau,  Apr.  25,  1957.  Unpublished. 

(128)  "Addiction — ^the  present  situation."  Read,  Bahamas  Medical  Con- 
ference, Nassau,  Apr.  25,  1957.  Unpublished. 

(129)  Nathan  B.  Eddt,  H.  Halbach,  and  Olav  J.  Braenden.  "Synthetic  sub- 

stances with  morphine-like  effect.  Clinical  experience :  Potency,  side 
effects  and  addiction  liability."  Bull.  World  Health  Orgn.,  27;  569,  1957. 

(130)  Nathan  B.  Eddy,  James  G.  Murphy,  and  Everette  L.  May.  "Structures 

related  to  morphine  :  IX.  Extension  of  the  Grewe  morphinan  synthesis 
in  the  benzomorphan  series  and  pharmacology  of  some  benzomorphans." 
J.  Org.  Chem.,  22: 1070,  1957. 

(131)  Nathan  B.  Eddy,  Red  wig  Besendorf,  and  Bela  Pellmont.  "Synthetic 

Analgesics :  IV.  Aralkyl  substitution  on  nitrogen  of  morphinan.  "U.N. 
Bull.  Narc.  10:  (No.  4) ,  23, 1958. 
(131a)   Lyndon  F.  Small.  Nathan  B.  Eddy,  J.  Harrison  Ageu.  and  Everette  L. 
May.  "An  improved  synthesis  of  N-phenethylnormorphine  and  analogs." 
J.  Org.  Chem.,  23: 1387,  1958. 
1 132)   Nathan  B.  Eddy  and  Lyndon  E.  Lee,  Jr.  "The  analgesic  equivolence  to 
morphine  and  relative  side  reaction  liability  of  oxymorphone    (14-hy- 
droxy-dihydromorphinoue)."  J.  Pharmacol.  &  Exper.  Therap.,  125:  No.  2, 
February  1959. 

(133)  Nathan  B.  Eddy,  Lyndon  E.  Lee,  Jr.,  and  Cari.  A.  Harris.  "The  rate  of  de- 

velopment of  physical  dependence  and  tolerance  to  analgesic  drugs  in 
patients  with  chronic  pain :  I.  Comparison  to  morphine,  oxymorphone 
and  anileridine."  Bull.  Narc,  11:  Nos.  1,  3, 1959. 

(134)  Nathan  B.  Eddy  and  Harris  Isbell.  "Addiction  liability  and  narcotics 

control."  Public  Health  Reports,  7.J;  755,  September  1959. 

(135)  Nathan  B.  Eddy.  "Chemical  structure  and  action  of  morphine-like  anal- 

gesics and  related  substances."  Sixth  Lister  Memorial  Lecture.  Chem.  & 
Indust.,  47.-  14H2  November  1959. 

(136)  Nathan  B.  Eddy,  Lyndon  E.  Lee,  Jr.,  and  Carl  A.  Harris.  "Dependence 

physique  et  tolerance  vis-a-vis  de  certains  analgesiques  chez  des  malades 
souffrant  de  douleurs  chroniques.  Comparison  entre  la  morphine,  I'oxy- 
morphoneet  I'anileridine."  Bull.  Org.  Sante,  20: 1245,  1959. 

(137)  Nathan   B.   Eddy,   Modeste  Piller,   Leo  A.   Pirk,  Otto  Schrappe,  and 

SiGUARD  Wende.  "The  effect  of  the  addition  of  a  narcotic  antagonist  on 
the  rate  of  development  of  tolerance  and  physical  dependence  to  mor- 
phine." Bull.  Narc,  12:  No.  4, 1959. 

(138)  Everette  L.  May  and  Nathan  B.  Eddy.  "A  new  potent  synthetic  anal- 

gesic" J.  Org.  Chem.,  2J,:  294, 1959. 

(139)  Everette  L.  May,  and  Nathan  B.  Eddy.  "Structures  related  to  morphine: 

XII.  ( ± )  -2'-Hydroxy-5,9-dimethyl-2-phenethyl-6,7-benbomorphan  ( NIH- 
7519)  and  its  optical  forms."  J.  Org.  Chem.,  24:  1435-1437,  19.59. 

(140)  Paul  A.  J.  Janssen  and  Nathan  B.  Eddy.  "Comiwunds  related  to  pethi- 

dine :  IV.  New  general  chemical  methods  of  increasing  the  analgesic 
activity  of  pethidine."  J.  Med.  Pharmaceut.  Chem.,  2:  31.  I»i0. 

(141)  J.  R.  Nicholls  and  Nathan  B.  Eddy.  "The  assay,  characteristics,  compo- 

sition and  origin  of  opium.  No.  97.  Analysis  of  samples  of  opium  of 
unknown  origin."  United  Nations,  ST/SOA/Ser.  K/97,  February  19, 
1960. 

(142)  BENJAJfiN  J.  CiLiBEKTi  AND  Nathan  B.  Eddy.  "Preanesthetic  medication: 

morphine,  anileridine,  oxymorphone,  and  placebo."  Bull.  Narc,  13 :  Nos. 
3,  1,  1961. 

(143)  Everette  L.  May  and  Nathan  B.  Eddy.  "The  assay,  characteristics,  com- 

position, and  origin  of  opium.  No.  111.  The  analysis  of  authenticated 
opium  samples  bv  means  of  direct  absorption  spectrophotometry."  United 
Nations,  ST/SOA/Ser.  K/Hl,  October  6,  1961. 


50 

<144)  Nathan  B.  Eddy,  H.  M.  Fales,  E.  Haahti,  P.  F.  Highet,  E.  C.  Horning, 
E,  L.  May,  and  W.  C.  Wildman.  "The  assay,  characteristics,  composi- 
tion, and  origin  of  opium.  No.  114.  Identification  and  analysis  of  opium 
samples  by  linear-programed  gas  chromatography."  United  Nations, 
ST/SOA/Ser.K/114,  Oct.  6,  1961. 

(145)  Maxwell  Gordon,  John  J.  Laffebty,  David  H.  Tedeschi,  Nathan  B. 

Eddy,  and  Everette  L.  May.  "A  new  potent  analgetic  antagonist."  Na- 
ture, 192 :  1089. 1961 . 

(146)  Maxwell   Gordon,    John   J.   Lafferty,   Blaine   M.    Sutton,   David   H. 

Tedeschi,  Nathan  B.  Eddy  and  Everette  L.  May.  "New  benzomorphan 
analgetics."  J.  Med.  Pharmaceut.  Chem.,  1962.  In  press. 

(147)  Nathan  B.  Eddy  and  Hans  Halbach.  "Synthetic  substances  with  mor- 

phine-like effect:  V.  Tests  for  addiction."  Bull.  World  Health  Organi- 
zation, 1962.  In  press. 

(148)  Nathan  B.  Eddy  and  Everette  L.  May.  "Synthetic  Analgesics,  Part  2,  B. 

Benzomorphans"  Pergamon  Press,  1962.  In  press. 

(149)  H.  Halbach  and  Nathan  B.  Eddy.  "Tests  for  addiction  (chronic  intoxi- 

cation) or  morphine  type."  Bull.  World  Health  Organization,  1963, 
28 :  139 

<150)  Nathan  B.  Eddy.  "Statement  on  Relative  Safety  of  Codeine  Prepara- 
tions." Read,  Senate  Committee  on  Judiciary,  California  Senate,  Sacra- 
mento, Calif.,  Mar.  8, 1963. 

(151)  — ^ "The  role  of  the  National  Academy  of  Sciences  and  the  National 

Research  Council."  Proceedings  White  House  Conference  on  Narcotic  and 
Drug  Abuse,  Washington,  D.C.,  Sept.  27-28, 1962,  p.  136. 

(152) "The  chemo-pharmacological  approach  to  the  problem  of  drug  ad- 
dition." Read,  Conference  on  Drug  Addiction,  University  of  California 
at  Los  Angeles,  Apr.  27-28,  1963.  U.S.  Public  Health  Report  (1963)  78: 
673.    Proceedings    of   the   conference.    McGraw-Hill    (1964).    In    press. 

(153)  Nathan  B.  Eddy,  B.  Ciliberti,  and  Phyllis  F.  Shroff.  "Preanaesthetic 
medication."  Bull.  Narcotics  (1964)  16  :  No.  2,  41. 

<154)  Nathan  B.  Eddy.  "Drug  addiction  and  the  law."  Britannica  Book  of  the 
Year  (1964),  291. 

(155) "The  search  for  a  nonaddicting  analgesic."  Proc.  of  symposium  on 

history  of  narcotic  drug  addiction  problems.  Mar.  27-28,  1958.  Public 
Health  Service  publication  No.  1050,  U.S.  Gov.  Print.  Off.  (1963). 

Chairman  Peppp:e.  We  will  now  take  a  5-minute  recess. 

(A  brief  recess  was  taken.) 

Chairman  Peppee.  The  committee  will  come  to  order,  please. 

Dr.  Brill,  would  you  please  come  forward. 

Our  next  witness  today  is  Dr.  Henry  Brill,  ca  distinguished  psychia- 
trist and  hospital  administrator. 

Dr.  Brill,  a  graduate  of  Yale  College  and  Yale  Medical  School, 
served  his  internship  at  Pilgrim  State  Hospital  in  New  York,  the 
same  facility  that  he  now  serves  as  director. 

Dr.  Brill  is  a  diplomate  of  the  American  Board  of  Neurology  and 
Psychiatry,  a  fellow  of  the  American  Psychiatric  Association,  and  a 
certified  mental  hospital  administrator. 

He  has  served  as  assistant  commissioner  for  research  and  medical 
services  of  the  New  York  Department  of  Mental  Plygiene :  and  vice 
chairman  of  the  New  York  State  Narcotic  Addiction  Control 
Commission. 

PTe  has  been  director  of  Pilgrim  State  Plospital,  with  time  out  for 
some  of  his  other  appointments,  since  1958. 

Dr.  Brill  has  served  as  clinical  professor  of  psychiatry  at  Albany 
Medical  College  and  as  professional  lecturer  at  Upstate  Medical  Cen- 
ter in  Syracuse,  N. Y. 

He  is  presently  a  lecturer  in  psychiatry  at  Columbia  Uiiiversity-s 
College  of  Physicians  and  Surgeons,  and  clinical  professor  of  psychia- 
try at  the  New  York  School  of  Psychiatry. 


51 

In  the  past,  Dr.  Brill  has  served  as  president  of  both  the  American 
College  of  Neuropsychopharmacology  and  the  Eastern  Psychiatric 
Research  Association.  He  is  currently  president-elect  of  the  American 
Psychopathological  Association. 

In  addition  to  serving  on  the  editorial  boards  of  four  scientific  jour- 
nals, Dr.  Brill  is  a  member  and  past  chairman  of  the  American  Medi- 
cal Association's  Committee  on  Drug  Dependence  and  Alcoholism;  a 
member  and  past  chairman  of  the  National  Research  CounciFs  Com- 
mittee on  Drug  Dependence,  and  was  recently  appointed  to  the  Presi- 
dent's Commission  on  Marihuana  and  Drug  Abuse. 

In  1965,  Dr.  Brill  was  chairman  of  the  methadone  maintenance 
evaluation  advisory  committee  of  the  Columbia  School  of  Public 
Health. 

I  have  taken  the  time  to  list  but  a  few  of  Dr.  Brill's  many  profes- 
sional appointments  and  accomplishments.  I  will  not  detail  the  over 
100  papers  in  the  field  of  psychiatry,  administration,  somatic  theory, 
and  drug  dependence  he  has  authored. 

Dr.  Brill,  we  are  greatly  honored  that  you  have  taken  time  from 
your  busy  schedule  to  share  your  immense  knowledge  with  us. 

Mr.  Perito,  would  you  make  the  inquiries  ? 

Mr.  Perito.  Thank  you,  Mr.  Chairman. 

Dr.  Bril],  I  understand  you  have  a  prepared  statement  ? 

STATEMENT  OE  DE.  HENEY  BRILL,  DIRECTOR,  PILGRIM 
STATE  HOSPITAL,  NEW  YORK,  N.Y. 

Dr.  Brill.  I  have. 

Mr.  Perito.  Would  you  care  to  read  that  statement  or  just  sum- 
marize it? 

Dr.  Brill.  I  would  like  to  skip  through  it  because  much  of  it  re- 
peals what  you  have  already  heard  this  morning. 

Chairman  Pepper.  Doctor,  without  objection,  your  full  statement 
will  appear  in  the  record,  and  you  may  give  such  summary  of  it  as  you 
will. 

Dr.  Brill.  Thank  you,  sir. 

I  think  what  I  would  like  to  stress  here  is  that  the  question  before 
your  committee,  as  has  been  mentioned,  was  already  brought  up  in 
1051,  but  it  is  different  in  one  important  respect.  In  1951,  the  question 
was  asked  what  would  happen  in  a  state  of  national  emergency  when 
stocks  of  opiuni  derivatives  were  exhausted  and  not  to  be  replenished. 
Now,  today  this  Nation  is  in  a  secure  position  with  respect  to  such  an 
emergency,  and  I  think  that  you  already  have  heard  that  we  haA-e  good 
substitutes  under  such  circumstances  so  there  would  be  no  emergency 
in  the  medical  practice  if  the  supplies  were  cut  off. 

I  would  also  like  to  point  out  that  this  is,  to  a  significant  degree,  the 
direct  result  of  a  major  coordinated  research  in  which  the  iSTational 
Academy  of  Medicine-National  Research  Council  Committee  played 
an  important  role  under  the  leadership  of  Dr.  Nathan  Eddy,  who  was 
its  chairnian  for  most  of  the  time,  since  1951,  and  I  might  also  add  that 
another  important  element  was  the  work  of  Dr.  Maurice  Seevers,  whom 
you  have  heard  this  morning. 

You  now,  as  I  understand  it,  are  interested  in  the  situation  with  re- 
spect to  a  complete  substitution  in  a  nonemergency  situation,  and  this 


52 

entails  the  consideration  of  additional  important  factors,  factors  in 
jiddition  to  those  coiisidered  in  response  to  the  first  question:  That  is 
the  established  patterns  of  medical  and  pharmaceutical  practice,  and 
I  might  add.  it  also  relates  to  the  habits  of  the  public  with  respect  to 
the  medication  they  take,  because  one  of  these  medications-  codeine, 
is  extensively  self-administered  for  the  treatment  of  cou^h. 

From  all  ])ersonal  experience,  I  am  led  to  believe  that  tlie  synthetics 
are  playing  a  large  and  growing  role  in  the  practice  of  medicine,  yet 
it  appears  the  natural  opium  products  and  their  derivatives  are  still 
extensively  used  in  spite  of  the  availability  of  heavily  advertised  syn- 
thetic rei)lacements,  and  these  synthetics  are  being  heavily  advertised 
in  the  medical  press  at  least.  The  TT.N.  publication  "Statistics  on  Nar- 
cotic Drugs  for  lOGO."  table  o,  indicates  that  the  amou.nt  of  morphine 
converted  into  '^odeine  actually  rose  worldwide  from  112.350  kilo- 
grams in  1905  to  146,000  kilograms  in  1969,  and  the  corresponding 
U.S.  figures  rose  from  20,000  kilograms  to  28,000  kilograms,  v.-hir>h 
points  to  a  marked  public  acceptance  of  the  use  of  codeine  in  current 
practice. 

The  increases  were  irregular,  but  the  figures  seemed  to  show  that 
the  natural  products,  and  especially  codeine,  continue  to  play  a  very 
large  role  in  world  medicine  and  in  the  United  States,  and  that  the 
U.S.  share  is  significant  but  by  no  means  decisive  in  the  overall  figures. 

It  would  thus  seem  that  in  a  plan  to  influence  the  dru<i'  dependence 
field  by  terminating  the  use  of  natural  products  would  call  for  re- 
orientation of  this  aspect  of  medical  practice  within  the  Ignited  States 
and  in  other  countries  as  well.  Quantitativelv  the  story  relates  to  co- 
deine. The  issue  which  would  have  to  be  considered  includes  the  relative 
costs  of  the  natural  and  synthetic  products  and  the  relative  familiarity 
of  public  and  the  health  professions  with  the  many  characteristics  of 
each  of  the  various  drugs  because  in  practice  few  drugs  are  entirely  07- 
essentially  identical.  They  tend  to  vary  among  themselves  as  to  speed 
and  duration  of  their  primary  action  and  the  relative  intensity  and 
timing  of  their  many  other  properties.  From  all  available  information, 
it  would  seem  that  a  replacement  is  technically  feasible  Init  it  would 
also  appear  that  this  would  call  for  full  considtation  with  organized 
medicine  and  pharmacy.  In  order  to  be  fully  accepted,  such  a  transition 
would  require  further  research  to  explore  the  many  pharmacological 
characteristics  of  the  substitute  drugs — and  this  includes  the  question 
of  teratogenicity,  which  is  a  thorny  question  at  the  present  moment, 
the  capacity  to  create  deformities  in  unborn  children — in  the  multi- 
plicity of  clinical  situations  and  the  many  conditions  under  which  the 
drugs  are  used  and  this  would  call  for  extensive  laboratory  studies 
and  clinical  investigations.  Because  when  a  drug  comes  out  of  a  labora- 
tory and  comes  into  clinical  practice  there  is  a  large  empirical  element 
that  must  enter  into  it,  because  no  laboratory  can  ever  go  into  all  the 
various  complex  situations  that  are  liable  to  be  faced  in  actual  mcMlical 
practice.  They  can  approximate  it,  but  they  can't  totally  reproduce  it. 

I  appreciate  the  opportunity  to  appear  before  this  body  and  realize 
that  there  is  room  for  nnich  clifference  of  opinion  on  all  these  matters 
but  have  sought  to  identify  the  prol)loms  which  would  seem  to  require 
solution  in  connection  with  the  proposal  which  is  before  you.  Under 
emergency  conditions  the  synthetic  drugs  which  we  now  have  would 
fully  replace  the  natural  products  in  control  of  i^ain  and  for  other 


53 

indications  but  under  nonemergency  conditions  it  would  seem  that 
the  immediate  reorientation  of  medical  and  pharmaceutical  procedures, 
on  the  scale  implied  in  the  U.S.  figures,  would  require  a  major  effort, 
although  there  are  strong  indications  that  the  long-term  trend  lies  in 
this  direction,  that  is,  in  the  direction  of  the  gradual  substitution  of 
he  natural  products  by  the  introduction  of  synthetics. 

Thank  you,  sir. 

Chairnian  Pepper.  Doctor,  what  needs  to  be  done,  in  addition  to  what 
has  already  been  done,  to  justify  Congress  in  prohibiting  the  impor- 
tation of  any  deri^'ati\'GS  of  opium  so  as  to  lead  to  the  stoppage  of  the 
growing  of  the  opium  poppy  ?  Do  you  think  additional  research  is  nec^ 
essary,  and  if  so,  are  additional  funds  required  ?  What  more  needs  to 
be  done^ 

Dr.  Brill.  I  would  say  yes  to  both  counts.  For  example,  a  synthetic 
way  of  producing  codeine  which  hasn't  yet  been  achieved  or  a  synthetic 
which  will  substitute  completely  for  codeine — and  we  do  not  have  a 
drug  which  is  exactly  like  codeine — both  of  these  would  be  well  worth- 
while in  connection  with  the  proposal,  and  they  call  for  research. 

In  addition,  if  I  may,  there  is  a  large  amount  of  investigation  that 
needs  to  be  done  and  has  not  been  done  in  connection  with  many,  many 
interesting  products  that  have  been  tested  and  are  available  for  fol- 
lowup  but  have  not  been  thoroughly  investigated  because  of  a  lack  of 
funds. 

Chairman  Pepper.  Doctor,  what  do  you  consider  the  state  of  develop- 
ment of  antagonistic  drugs  to  heroin  addiction? 

Dr.  Brill.  I  think  we  are  at  the  beginning,  sir.  Naloxone  is  one  drug 
which  is  quite  acceptable  to  those  patients  who  are  willing  to  take  the 
antagonist  and  the  supply  is  as  yet  not  extensive.  I  think  that  this  is 
now  being  developed,  but  we  need  a  substance  which  will  have  a  longer 
action  tlian  naloxone  has.  But  I  must  also  point  out  that  many  pa- 
tients will  refuse  to  take,  many  addicts  will  refuse  to  take,  antago- 
nists. This  is  from  my  personal  experience. 

Chairman  Pepper.  Are  you  informed  about  the  methadone  experi- 
ment in  New  York '? 

Dr.  Brill.  , Yes. 

Chairman  Pepper.  "Would  you  comment  on  the  use  of  methadone  in 
the  treatment  of  heroin  addiction? 

Dr.  Brill.  When  methadone  is  used  along  the  lines  that  Dr.  Eddy 
outlined,  when  it  is  properly  used  in  a  program  of  treatment,  it  can 
produce  results  which  I  think  are  better  than  any  other  techniques 
that  I  know  for  a  certain  number  of  addicts  whose  condition  is  intrac- 
table to  any  other  procedure.  But  when  methadone  is  used  by  other 
methods,  by  other  techniques  and  in  other  ways,  it  can  become  a  pub- 
lic health  hazard  and  the  essential  difference  between  the  medical  use 
of  methadone  and  the  abuse  of  methadone  is  that  the  medical  use  of 
methadone  provides  physical  saturation,  saturation  of  the  physical 
need  but  it  produces  no  mental  effect.  "Whereas,  if  the  drug  is  used  in 
such  a  way  as  to  produce  mental  effects  it  produces  all  the  harm  of  ad- 
diction as  we  know  it.  It  produces  mental  effect  when  it  is  injected  in- 
travenously and  when  it  is  taken  orally  by  beginners  on  an  irregular 
basis. 


54 

Chairman  Pepper.  Have  you  found  tliat  the  use  of  methadone  in  the 
New  York  experiment  with  which  you  are  familiar  has  reduced  the 
amount  of  crime  committed  by  the  heroin  addict  treated  ? 

Dr.  Brill.  In  the  cases  that  are  under  treatment,  the  statistics  are 
quite  spectacular.  The  amount  of  crime  was  reduced  by  over  85  per- 
cent. But  I  cannot  say  that  there  was  an  impact  on  the  overall  crime 
statistics,  althou<ili  I  knoAv  how  difficult  it  is  to  eA^aluate  overall 
crime  statistics.  But  among  the  population  that  followed  the  metha- 
done treatment,  the  reduction  in  crime  is  spectacular. 

Chairman  Pepper.  Mr.  Perito,  do  you  have  any  questions  of  Dr. 
Brill? 

Mr.  Pertto.  a  couple  of  brief  ones,  Mr.  Chairman. 

Dr.  Brill,  how  would  it  be  best  to  coordinate  the  eflForts  of  or- 
ganized medicine  to  move  toward  the  use  of  synthetic  analgesics  ? 

Dr.  Brill.  You  mean  to  advance  the  use  of  existing  synthetics  or 
new  synthetics  ? 

Mr.  Perito.  Existing  synthetics. 

Dr.  Brill  I  think  an  educational  program  would  be  useful.  I  think 
there  is  relatively  little  problem,  as  Dr.  Eddy  pointed  out,  in  connec- 
tion with  the  use  of  synthetics  for  the  control  of  pain  in  connection 
with  operations  and  major  surgery  or  major  accidents  and  this  kind 
of  thing. 

The  real  problem  is  in  the  use  of  codeine  as  an  analgesic  and  an 
antidepressant  for  the  control  of  cough.  Hero  the  drug  has  a  combi- 
nation of  qualities  that  are  not  easily  mimicked. 

Mr.  Perito.  Would  you  acquiesce  in  the  judgment  of  Dr.  Eddy  that 
methadone  should  not  be  distributed  by  private  physicians  but  should 
only  be  distributed  in  a  coordinated  clinical  atmosphere  with  proper 
support  services? 

Dr.  Brh^l.  Most  certainly. 

Chairman  Pepper.  Mr.  Mann. 

Mr.  Mann.  No  questions,  Mr.  Chairman. 

Chairman  Pepper.  Mr.  Wiggins? 

Mr.  Wiggins.  Doctor,  your  testimony  indicated  that  one  of  the 
problems  with  the  synthetics  is  that  they  have  not  been  thoroughly 
tested  to  know  fully  their  impact  in  general  clinical  use.  But  isn't 
it  so.  Doctor,  that  many  of  these  substitutes  are  now  in  clinical  use  ? 

Dr.  Brill.  Yes,  sir ;  they  are.  Unfortunately,  it  takes  years  of  clinical 
use  before  all  the  ramifications  of  a  drug  can  be  identified.  For  exani- 
ple,  we  take  one  of  the  commonest  drugs  in  clinical  use,  and  that  is 
tobacco.  It  was  in  clinical  use  for  hundreds  of  years  before  anyone 
suspected  that  it  might  possibly  lead  to  pathologies  in  the  lungs  and 
so  on.  So  the  same  has  happened  over  and  over  again  with  ncAvly 
introduced  drugs.  After  they  have  been  on  the  market  for  a  while, 
questions  have  been  raised. 

Antidiabetic  drugs  recently  had  questions  raised  about  them  which 
are  not  fully  answered  as  yet.  It  is  a  controversial  subject,  as  you  know. 

So  the  fact  that  a  drug  is  in  clinical  use  is  reassuring,  but  not  totally 
reassuring. 

Mr.  Wiggins.  Doctor,  simply  because  questions  exist  and  probably 
will  always  exist,  are  you  satisfied  that  those  questions  standing  alone 
are  sufficient  reason  not  to  warrant  a  statute  which  would  outlaw 
morphine  and  thereby  force  the  general  clinical  use  of  the  substitute  ? 


55 

Dr.  Brill.  I  think  there  would  be  less  difficulty  with  a  statute  out- 
lawino:  morphine  than  with  a  statute  outlawing  all  opium  products. 
I  think  it  would  be  relatively  simple  to  outlaw  morphine,  although 
there  would  be,  as  has  been  brought  out  here,  professional  questions 
raised  both  on  the  grounds  of  familiarity  with  the  morphine  and  on 
the  grounds  that  there  is  a  reluctance  to  have  such  things  legislated. 
But  this  is  not,  as  I  see  it,  the  major  problem. 

Mr.  Wiggins.  The  point  was  made  by  Dr.  Eddy  that  the  medical 
profession  would  require  a  period  of  orientation  and  education.  How 
long  do  you  suppose  would  be  appropriate  for  that  purpose? 

Dr.  Brill.  If  I  might  add  to  that  question,  it  might  be  well  to  allow 
organized  medicine  to  come  in  and  make  its  comments. 

Mr.  Wiggins.  They  will  be  invited  to  do  so. 

(See  Exhibit  1.) 

Dr.  Brill.  Yes. 

Chairman  Pepper.  Yes. 

Dr.  Brill.  I  hesitate  to  speak  for  organized  medicine,  but  it  cer- 
tainly couldn't  be  done  in  less  than  several  years  to  the  satisfaction  of 
most  people. 

Mr.  Wiggins.  That  is  all  the  questions  I  have. 

Chairman  Pepper.  Mr.  Steiger? 

Mr.  Steiger.  Thank  you,  Mr.  Chairman. 

Doctor,  the  summation  of  your  testimony  and  that  of  Dr.  Eddy  and 
Dr.  Seevers  is  that  there  is  no  medical  reason  for  retaining  the  natural 
analgesic,  whatever  the  medical  term  is.  Now,  Doctor,  as  a  layman,  it 
occurs  to  me  that  we  have  had  painted  here  this  morning  a  rather  un- 
flattering picture  of  the  medical  profession,  because  we  say  we  arrive 
on  a  conclusion  based  on  a  question  posed  in  1951,  the  conclusion  being 
that  in  a  physical  emergency  in  which  opium  was  not  available  the 
medical  profession  could  readily  adjust.  Now,  we  understand,  and 
rather  thoroughly,  from  the  testimony  that  it  would  be,  one,  inconven- 
ient and  it  would  be  what  is  termed  justifiable  for  natural  resistance 
to  any  change,  it  would  be  difficult  to  stop  cough. 

Now,  I  think,  it  seems  to  me  unfair  to  the  medical  profession — I 
wouldn't  want  to  just  leave  it  lying  there — that  the  inconvenience,  the 
comfortable  familiarity  with  the  existing  natural  opiates,  all  of  these 
things  of  themselves  are  so  important  that  the  evils  that  the  opiate 
now  represents  are  going  to  be  somehow  set  aside.  It  would  be  easy  for 
those  of  us  in  the  political  arena — and  I  am  sure  some  of  us  will — to 
call  this  an  emergency  situation.  We  truly  have  an  emergency.  There 
are  many  areas  in  which  the  emergency  is  very  genuine.  The  chairman, 
I  think,  defined  it  pretty  well  at  the  outset. 

I  would  hope  that  possibly — obviously  the  most  comfortable  thing 
for  us,  and  we  are  interested  in  our  comfort,  too — would  be  for  the 
medical  profession  to  come  forth  and  say  now  is  the  time  and  for  the 
medical  profession  to  declare  this  an  emergency  and  for  the  medical 
profession  to  say  these  synthetics  work,  they  will  use  them,  those  who 
have  coughs  will  perhaps  have  to  cough  a  little. 

I  don't  honestl}'^  know  what  the  clinical  situation  is.  But  I  know 
that,  again,  just  having  heard  this  and  having  considered  myself  a 
friend  of  medicine,  I  think  we  are  painting  medicine  accurately,  per- 
haps, but  unfairly  nevertheless. 


56^. 

I  wonder  would  you  care  to  comment,  and  I  suspect  it  is  rather  un- 
fair, but  on  the  likelihood  of  the  medical  profession  feeling  the  need 
to  come  forward  and  say  let's  do  this  thing. 

Dr.  Brill.  I  think  that  the  real  issue  is  the  feeling  of  the  public.  The 
medical  pi-ofession  can  only  represent  the  patient  in  this  area,  because 
the  doctor  deals  with  a  patient,  and  the  indications  for  the  use  of 
codeine,  for  example,  are  not  indications  of  life  and  death.  They  are 
relatively  minor  indications. 

But  I  think  all  any  technical  person  can  do  is  to  venture  an  opinion 
as  to  whether  a  drug  can  be  fully  substituted  to  the  satisfaction  of  the 
patient  or  whether  the  substitution  will  not  be  equally  satisfactoiy  to 
the  patient.  I  think  it  would  be  misleading,  from  my  point  of  view,  if 
I  were  to  say  that  in  my  opinion  drugs  wdiich  would  replace  codeine 
would  be  just  as  satisfactory  to  the  patient  as  codeine  now  is,  particu- 
larly keeping  in  mind  that  much  of  the  codeine  is  over  the  counter 
where  the  physician  doesn't  enter  into  it  at  all. 

But  the  bar  is  not  an  absolute  bar.  It  is  a  question  of  cost-benefit 
ratios,  and  T  am  not  in  a  position  to  judge  the  benefits.  I  think  these 
benefits  have  to  do  with  traffic  and  so  on,  which  I  don't  know  anything 
about. 

Mr.  Steiger.  I  understand.  All  right. 

Medically,  Doctor,  on  a  scale  of  1  to  10,  how  effective — and  putting 
codeine  at  10 — how  effective  are  the  known  codeine  substitutes  for 
cough  suppressants  on  this  scale  of  1  to  10,  and  would  that  be  sufficient 
to  make  the  abolishment  of  opium  and  Avhatever  benefits  would  derive 
on  a  national  basis?  Really,  I  guess  that  is  what  we  are  faced  with. 
Obviously  we  don't  want  to  impose  a  genuine  hardship  on  the  public. 
By  the  same  token  I  have  great  faith  in  the  medical  profession  being 
able  to  convince  the  public  that  what  we  are  prescribing  for  them  is 
good  for  them,  even  though  that  may  not  always  be  the  case. 

On  that  1  to  10  ratio,  what  would  you  say  ? 

Dr.  Brill.  Well,  as  a  rough  guess  I  would  say  two  or  three. 

Mr.  Steiger.  So  in  your  opinion  that  is  where  the  gap  lies,  then  ? 

Dr.  Brill.  There  is  a  possible  difference,  and  there  also  is  a  possible 
difference  between  the  usefulness  of  codeine  as  an  analgesic  in  many 
cases  and  the  usefulness  of  the  competing  analgesics.  I  think  it  is 
less  clear  cut.  These  are  matters  of  judgment  and  opinion  and  not 
easily  measured.  But  I  think  there  is  that  difference. 

But  I  must  again  say  that  much  of  this  codeine,  I  don't  know  what 
proportion — you  easily  can  find  out — much  of  the  codeine  used  has 
no  medical  intervention  at  all.  This  is  a  matter  of  public  habit. 

Mr.  Steiger.  I  must  say  is  not  used  medically  ? 

Dr.  Brill.  There  is  abuse  of  the  cough  mixtures.  That  is  true.  There 
also  is  abuse  of  synthetic  cough  mixtures.  So  that  is  an  even  tossup. 

Mr.  Steiger.  I  thank  you. 

Chairman  Pepper.  ^Ir.  Blommer,  any  questions? 

Mr.  Blommer.  No,  Mr.  Chairman. 

Chairman  Pepper.  Mr.  Winn? 

Mr.  WixN.  None,  Mr.  Chairman. 

Chairman  Pepper.  INIr.  Keating? 

Mr.  Keating.  None,  Mr.  Chairman. 


57 

Chairman  Pepper.  Dr.  Brill,  I  think  you  have  given  us  extremely 
valuable  testimony  this  morning.  You  know,  sometimes  we  can  be 
pushed  a  little  bit  to  get  to  the  conclusions  that  we  want  to  reach. 

I  very  much  sympathize  with  what  was  suggested  by  Mr.  Steiger. 

Is  codeine  used  largely  in  the  suppression  of  cough? 

Dr.  Brill.  Suppression  of  cough  and  for  the  control  of  minor  pains 
and  minor  discomforts.  It  is  an  analgesic. 

Chairman  Pepper.  Yv  e  hope  to  iiear  later  from  the  medical  associa- 
tion and  the  whole  medical  profession  on  this  subject.  We  w^ould  cer- 
tainly hope  that  they  would  take  the  lead  in  trying  to  move  as  rapidly 
as  possible,  because  Congress  is  faced  with  such  a  terrible  problem  in 
heroin  addiction.  I  believe  we  all  agree  that  it  is  growing  worse; 
isn't  it  i  (See  Exhibit  No.  1  for  AMA  views.) 

Dr.  Brill.  Yes,  sir ;  it  is. 

Chairman  Pepper,  ilie  problem  is  so  serious,  and  it  seems  impossible 
to  stop  it  by  law  enforcement,  which  catches  only  20  percent  of  the 
heroin  being  smuggled  into  this  country.  That  method  seems  so  im- 
probable of  success  that  we  have  to  turn  to  alternatives  to  see  what 
else  we  can  do. 

Dr.  Brill.  I  agree. 

Chairman  Pepper.  That  is  the  reason  we  are  trying  to  get  teclmical 
information,  scientific  knowledge  that  would  guide  the  Congress  in 
seeing  whether  or  not  we  may  safely  and  properly  move  in  this  direc- 
tion of  stopping  importation  of  opium.  If  we  could  stop  the  legal 
growing  of  the  opium  poppy  it  would  be  easier  to  police  a  ban.  We 
could  catch  it,  then. 

Dr.  Brill.  Thank  you. 

Chairman  Pepper.  Mr.  Perito  has  one  more  question? 

Mr.  Perito.  Dr.  Brill,  have  you  had  an  opportunity,  in  your  pro- 
fessional practice,  to  treat  and  evaluate  addicts  who  have  been  given 
antagonists  ? 

Dr.  Brill.  Yes. 

Mr.  Perito.  What  is  your  professional  opinion  about  the  possibili- 
ties of  developing  antagonists  to  the  point  w^here  they  will  become  an 
effective  weapon  o^  the  clinician  in  the  treatment  of  drug-dependent 
persons  ? 

Dr.  Brill.  I  think  it  is  a  very  good  possibility  and  a  very  excellent 
lead  to  follow.  I  wouldn't  want  to  leave  the  impression  that  this  is  a 
panacea,  but  the  antagonists  certainly  are  one  of  the  best  leads  that 
I  know  of. 

Chairman  Pepper.  Are  more  funds  necessary,  in  your  opinion,  to 
carry  on  the  developmental  work  in  the  finding  of  these  solutions  for 
opium  derivatives  and  finding  antagonistic  drugs  to  heroin  addiction  ? 

Dr.  Brill,  Yes,  sir;  to  my  personal  knowledge  many  of  the  most 
important  research  activities  in  the  country  today  in  this  field  are 
feeling  the  pressure  of  shortage  of  funds,  and  I  think  that  this  is 
something  that  I  have  to  call  to  your  attention. 

Chairman  Pepper.  The  Federal  Government  might  well  interest 
itself  in  providing  more  funds  ? 

Dr.  Brill.  I  think  so. 

Chairman  Pepper.  Anything  else  ? 

Mr.  Perito.  Mr.  Chairman,  may  we  have  incorporated  in  the  record 
Dr.  Brill's  prepared  statement;  also,  Dr.  Brill's  curriculum  vitae. 

60-296  O — 71— pt.  1 5 


58 

Chairman  Pepper.  Without  objection,  they  will  be  admitted. 
Thank  you  very  much  Doctor,  for  coming  today. 
(The  material  referred  to  follows :) 

[Exhibit  No.  5(a)] 

Prepared  Statement  of  Dr.  Henry  Brill,  Director  of  Pilgram  State 

Hospital,  New  York,  N.Y. 

On  the  feasibility  of  replacing  natural  opium  products  with  totally 
synthetic  substances  in  medical  practice. 
Mr.  Chairman  and  Members  of  the  Committee:  I  am  Dr.  Henry  Brill  of 
Brentwood,  N.Y.,  and  a  member  of  the  committee  on  alcoholism  and  drug  de- 
pendence of  the  American  Medical  Association  and  the  Committee  on  Problems 
of  Drug  Dependence  of  the  National  Research  Council.  I  am  also  immediate  past 
chairman  of  both  committees  and  a  member  of  the  World  Health  Organization 
Expert  Committee  on  Drug  Dependence.  However,  my  statement  here  today  is 
made  in  a  purely  personal  capacity  and  I  am  not  here  as  a  representative  of  any 
group  or  organization. 

I  believe  you  already  have  testimony  to  the  effect  that  as  long  ago  as  19ol,  the 
Committee  on  Drug  Addiction  and  Narcotics  (now  the  Committee  on  Problems 
of  Drug  Dependence),  National  Academy  of  Science-National  Research  Council 
was  questioned  about  the  possibility  of  completely  replacing  natural  opium 
products  with  synthetic  substances  in  the  practice  of  medicine.  The  answer  at 
that  time  was  a  qualified  affirmative  and,  as  you  know,  the  answer  today  has 
become  an  unqualified  aflSrmative.  With  this  I  fully  concur  and  agree  that  from 
the  scientific  and  pharmacological  point  of  view,  such  a  substitution  is  entirely 
practicable. 

The  question  now  before  your  group  is  different  from  that  which  was  posed 
in  1951.  That  question  related  to  a  state  of  national  emergency  in  which  it  was 
assumed  that  stocks  of  opium  were  exhausted  and  irreplenishable.  Today  this 
Nation  is,  I  believe,  in  a  secure  position  with  respect  to  such  an  emergency  and 
this  improvement  is  to  a  significant  degree  the  direct  result  of  a  major  coordi- 
nated research  effort  in  which  the  National  Academy  of  Medicine-National  Re- 
search Council  Committee  played  a  prominent  role  under  the  leadership  of  Dr. 
Nathan  Eddy  who  was  its  chairman  for  most  of  that  time. 

You  are  now  interested  in  the  situation  with  respect  to  a  complete  substitu- 
tion in  a  nonemergency  situation  and  this  entails  consideration  of  an  important 
factor  in  addition  to  those  considered  in  response  to  your  first  question  and  I 
refer  to  the  established  patterns  of  medical  and  pharmacological  practice. 

From  all  personal  exi^erience,  I  am  led  to  believe  that  the  synthetics  are  play- 
ing a  large  and  growing  role  but  yet  it  appears  that  the  natural  opium  products 
and  their  derivatives  are  still  extensively  used  in  spite  of  the  availability  of 
heavily  advertised  synthetic  replacements.  The  U.N.  publication  "Statistics  on 
Narcotic  Drugs  for  1969,"  table  5,  indicates  that  the  amount  of  morphine  con- 
verted into  codeine  actually  rose  worldwide  from  112,350  kilograms  in  1965  to 
146,084  kilograms  in  1969  and  the  corresponding  U.S.  figures  rose  from  20,089 
to  23,084  kilograms.  The  increases  were  irregular  but  the  figures  seem  to  show 
that  the  natural  products  continue  to  play  a  very  large  role  in  world  medicine 
and  in  the  United  States  and  that  the  U.S.  share  is  significant  but  by  no  means 
decisive  in  the  overall  figures. 

It  would  thus  seem  that  any  plan  to  influence  the  drug  dependence  field  by 
terminating  the  use  of  natural  products  would  call  for  reorientation  of  this 
aspect  of  medical  practice  within  the  United  States  and  in  other  countries  as 
well.  The  issue  which  would  have  to  be  considered  includes  the  relative  costs 
of  the  natural  and  synthetic  products  and  the  relative  familiarity  of  public  and 
the  health  professions  with  the  many  characteristics  of  each  of  the  various 
drugs  because  in  practice  few  drugs  are  entirely  or  e.'^sentially  identical.  They 
tend  to  vary  among  themselves  as  to  speed  and  duration  of  their  primary  action 
and  the  relative  intensity  and  timing  of  their  many  other  properties.  From  all 
available  information,  it  would  seem  that  a  replacement  is  technically  feasible 
but  it  would  also  appear  that  this  would  call  for  full  consultation  with  organized 
medicine  and  pharmacy.  In  order  to  be  fully  acceptable,  such  a  transition 
would  require  further  research  to  explore  the  many  pharmacological  character- 
istics of  the  substitute  drugs  in  the  multiplicity  of  clinical  situations  and  the 


59 

many  conditions  undef  which  the  drugs  are  used  and  this  would  call  for  ex- 
tensive laboratory  studies  and  clinical  investigations. 

I  appreciate  the  opportunity  to  appear  before  this  body  and  realize  that  there 
is  room  for  much  difference  of  opinion  on  all  these  matters  but  have  ;;ought 
to  identify  the  problems  which  would  seem  to  require  solution  in  connection 
with  the  proposal  which  is  before  you.  Under  emergency  conditions  the  synthetic 
drugs  which  we  now  have  would  fully  replace  the  natural  products  in  control 
of  pain  and  for  other  indications  but  under  nonemergency  conditions  it  would 
seem  that  the  immediate  reorientation  of  medical  and  pharmaceutical  procedures, 
on  the  scale  implied  in  the  U.N.  figures,  would  require  a  major  effort  although 
there  are  strong  indications  that  the  long-term  trend  lies  in  this  direction. 

[Exhibit  No.  5(b)] 

Curriculum  Vitae  of  Dr.  Henry  Brill,  Director,  Pilgrim  State 

(N.Y.)   Hospital 

1906  Born  Bridgeport,  Conn. 

1928  Graduate  Yale  College. 

1932  Graduate  Yale  Medical  School. 

1932-34  Medical  intern  Pilgrim  State  Hospital  (recognized  as  basis 

for  Nat.  Board  Part  III). 

1934  Licensed  New  York  State  (28727) . 

1938  Diplomateof  National  Board  (by  exam)  (6160). 

1938  Qualified  psychiatrist,  New  York  State. 

1940  Diplomate  of  American  Board  of  Neurology  and  Psychiatry. 

1951  Fellow  American  Psychiatric  Association. 

1957  Certified  Mental  Hospital  Administrator  (412) . 

1934-50  Resident,  Senior  Psychiatrist,  Clinical  Director  and  Associate 

Director,  Pilgrim  State  Hospital. 

1950-52  Director,  Craig  Colony  and  Hospital  (epilepsy) . 

1952-59  Assistant  Commissioner  for  Reserach  and  Medical  Services, 

Department  of  Mental  Hygiene,  New  York. 

1958-64  (Director,  Pilgrim  State  Hospital — on  leave). 

1959-64  Deputy  and  First  Deputy  Commissioner,  N.Y.  State  Depart- 

ment of  Mental  Hygiene  (Special  reference  to  Research 
Training  and  Medical  Services). 

1964-66  Director  Pilgrim  State  Hospital. 

1966-68  Vice  Chairman  NY  State  Narcotic  Addiction  Control  Com- 

mission (Director — on  leave — P.S.H.). 

1968  to  date  Director  Pilgrim  State  Hospital. 

teaching 

1955-64  Associate  Clinical  Professor  and  Clinical  Professor — Psychia- 

try— Albany  Medical  College. 
1958-64  Professional  lecturer — Upstate  Medical  Center,  Syracuse. 

1958  to  date  Lecturer — Psychiatry — College  of  Physicians  and  Surgeons, 

Columbia  University. 

1959  to  date  Clinical  Professor  of  Psychiatry,  New  York  School  of  Psy- 

chiatry. 


1964-68 


ORGANIZATIONAL 

Past  President  of  American   College  of  Neuropsychophar- 

macology  and  of  Eastern  Psychiatric  Research  Association. 
Currently     President-Elect     American     Psychopathological 

Association. 
Elected   to   Council   of  American   Psychiatric   Association; 

Council  Representative  to  Committee  on  Mental  Hospital 

Standards  and  Practices. 


EDITORIAL   BOARD 


1948  to  date  Psychiatry  Quarterly. 

1968  to  date  International  Journal  of  Addictions. 

1969  to  date  Psychopharmacologia. 
1971  to  date  Comprehensive  Psychiatry. 


60 


1958-68 

1959-«4 

1969 

1962-64 

1962 


1969 
1965 

1970 

1971 


COMMITTEES 

Member  and  Chairman  of  Advisory  Committee  Clinical  Psy- 
chopharmocolgy  NIMH. 

Member  and  Chairman  A.P.A.  Committee  on  Nomenclature 
and  Statistics  (DSM  II). 

Chairman  of  American  Psychiatric  Association  Task  Force 
on  Nomenclature  and  Statistics. 

Member  of  Subcommittee  on  Classification  to  U.S.  Surgeon 
General. 

Consultant  to  World  Health  Organization — Statistics  and  No- 
menclature (Psychiatry). 

Member  and  past  chairman  of  A.M.A,  Committee  on  Drug  De- 
pendence and  Alcoholism. 

Member  and  past  chairman  of  National  Research  Council — 
Committee  on  Drug  Dependence. 

Member  W.H.O.  Expert  Committee  on  Drug  Dependence. 

Chairman — Methadone  Maintenance  Evaluation  Advisory 
Committee  Columbia  School  of  Public  Health. 

Member  of  NY  State  Regents  Committee  on  Continuing  Edu- 
cation 

Member  of  Presidential  Commission  on  Marihuana  and  Drug 
Dependence 

On  various  Advisory  Committees — Department  of  Justice, 
FDA,  and  NIMH. 


1970 
1970 


PUBLICATIONS   AND   HONORS 

Author  of  over  100  papers  in  the  field  of  Psychiatry,  Admin- 
istration, Somatic  Therapy  and  Drug  Dependence. 
Member  of  Sigma  XI  and  Phi  Beta  Kappa. 
Recipient  Hutchings  Award. 
Listed  in  current  "Who's  Who  in  America." 


Chairman  Pepper.  Secretary  Rossides,  please. 

The  committee  is  pleased  to  call  now  the  Honorable  Eugene  T.  Ros- 
sides, Assistant  Secretary  of  the  Treasury  for  Enforcement  and 
Operations. 

Mr.  Rossides  serves  as  the  principal  law  enforcement  policy  advisor 
to  the  Secretary  of  the  Treasury.  His  responsibilities  include  provid- 
ing policy  guidance  for  all  Treasury  law  enforcement  activities,  as 
well  as  direct  supervision  of  the  Bureau  of  Customs,  the  U.S.  Secret 
Service,  the  Bureau  of  the  Mint,  the  Bureau  of  Engraving  and  Print- 
ing, the  Consolidated  Federal  Law  Enforcement  Training  Center,  the 
Office  of  Operations,  the  Office  of  Tariff  and  Trade  Affairs,  and  the 
Office  of  Law  Enforcement. 

Mr.  Rossides  also  serves  as  U.S.  Representative  to  Interpol,  the  in- 
ternational criminal  police  organization,  and  was  elected  one  of  three 
vice  presidents  of  Interpol  in  October  1969. 

From  1958  to  1961,  he  served  as  Assistant  to  Treasury  I'nder  Secre- 
tary Fred  C.  Scribner,  Jr.  Early  in  his  law  career,  Mr.  Rossides  served 
as  a  criminal  law  investigator  in  the  rackets  bureau  on  the  staff  of  Xew 
York  County  District  Attorney  Frank  S.  Hogan.  For  2  years,  he  was 
an  assistant  attorney  general  for  the  State  of  XeAv  York,  assigned  to 
the  bureau  of  securities  to  investigate  and  prosecute  stock  frauds.  A 
former  legal  officer  for  the  Air  Materiel  Command,  Mr.  Rossides  holds 
the  reserve  rank  of  Air  Force  captain. 

A  native  of  New  York,  Mr.  Rossides  received  his  A.B.  degree  from 
Columbia  College  and  his  law  degree  from  Columbia  Law  School. 


61 

Mr.  Rossides  is  a  vice  president  of  the  New  York  Metropolitan 
Chapter  of  the  National  Football  Foundation  and  Hall  of  Fame  and 
a  director  of  the  Touchdown  Club  of  New  York. 

Mr.  Rossides,  it  is  indeed  a  pleasure  to  have  you  with  us  today.  Al- 
though your  responsibilities  are  widespread,  I  understand  that  you 
are  going  to  limit  your  testimony  today  to  the  role  of  the  Bureau  of 
Customs  in  controlling  the  illicit  flow  of  heroin  into  the  United  States 
and  your  support  for  this  committee's  proposal  for  an  international 
ban  on  opium  cultivation. 

Mr.  Perito,  will  you  inquire  ? 

Mr.  Perito.  Secretary  Rossides,  I  understand  you  have  a  prepared 
statement  ? 

STATEMENT  OF  EUGENE  T.  KOSSIDES,  ASSISTANT  SECRETARY  OF 
THE  TREASURY,  ENFORCEMENT  AND  OPERATIONS 

Mr.  Rossides.  Yes ;  I  do. 

Mr.  Perito.  Would  you  care  to  present  that  to  the  committee  ? 

Mr.  Rossides.  Mr.  Chairman,  members  of  the  committee,  it  is  a  great 
pleasure  to  appear  again  before  this  committee. 

I  think  this  committee  has  done  some  of  the  most  significant  work 
that  has  been  done  in  Congress  in  this  area  of  narcotics — in  the  total 
area  of  the  narcotics  problem. 

I  am  pleased  to  be  here  today.  I  will  summarize  my  statement  and 
read  the  key  paragraph  regarding  the  committee's  inquiry. 

Mr.  Chairman  and  members  of  the  committee,  I  am  pleased  to  be 
here  at  the  request  of  the  committee  to  give  my  views  on  a  narrow  but 
significant  question ;  namely,  what  would  be  the  enforcement  effect  if 
there  were  an  adequate  supply  of  synthetic  substitutes  for  opium  and 
substances  derived  from  opium.  Put  another  way,  would  it  be  helpful 
in  preventing  the  illegal  growth  and  diversion  of  opium  and  the  prod- 
ucts of  heroin  and  its  smuggling  into  the  United  States.  As  back- 
ground, let  me  say  that  there  are  at  least  five  critical  points  in  the  ille- 
gal narcotics  traffic: 

( 1 )  The  growth  of  opium  poppies ; 

(2)  Illegal  diversion  of  opium; 

(3)  Illegal  production  of  morphine  and  heroin ; 

(4)  Smuggling  into  the  United  States ;  and 

(5)  Distribution  within  the  United  States. 

I  have  testified  before  this  committee  regarding  the  President's  six- 
point  action  program.  I  think  the  President  has  by  his  personal  inter- 
vention and  initiatives  elevated  the  drug  problem  to  a  foreign  policy 
level.  His  White  House  conferences  and  other  efforts  devoted  to  this 
problem  have  alerted  not  just  the  international  community  but  the 
national  community  as  well.  His  efforts  have  stimulated  debate,  re- 
search, education,  and  enforcement  and  have  recognized  the  role  of  the 
States  and  the  role  of  the  private  community  in  dealing  with  the  nar- 
cotics problem.  The  private  community  under  discussion  here  today, 
and  the  medical  profession  particularly,  have  an  enormous  role  to  play 
in  this  whole  problem. 

This  doesn't  mean  more  should  not  be  done.  But  I  do  feel,  and  it  is 
my  own  personal  judgment,  that  the  President's  action  program  has 
alerted  the  international  community  to  the  global  problem  of  drug 


62 

abuse  and  has  brought  about  the  action  needed  to  combat  it;  and  on 
the  national  scene,  has  arrested  our  incredible  downward  slide  into 
drug  abuse. 

As  I  have  testified  before,  however,  let  there  be  no  false  optimism. 
This  simply  means  we  have  stopped  the  downward  trend,  turned  it 
around,  and  have  a  long  way  to  go  to  come  back  to  the  level  at  which 
we  would  like  to  be. 

I  am  confident  we  Avill  meet  that  challenge,  because  it  has  become  a 
national  bipartisan  effort.  The  Congress  has  an  essential  role  as  does 
the  executive  in  this  entire  area.  The  private  community  has  a  role. 
The  States  have  the  central  role  in  law  enforcement,  in  the  distribu- 
tion of  needed  information,  in  education,  and  indeed  they  might  do 
more  in  research. 

With  this  background,  Mr.  Chairman  and  members  of  the  commit- 
tee, I  would  answer  the  committee's  inquiry  by  stating  that  in  enforce- 
ment terms  the  ban  on  opium  production  as  a  legal  item  would  be  a 
definite  plus.  When  there  is  no  legal  growth  of  poppies  permitted,  the 
enforcement  officials  will  clearly  have  a  much  easier  time  in  locating 
illegal  acreage. 

Secondly,  when  there  is  no  legal  acreage,  the  grower  does  not  have 
a  legal  supply  of  opium  from  which  to  withhold  and  divert  to  the 
illegal  market.  It  is  as  simple  as  that,  Mr.  Chairman. 
It  would  be  a  definite  plus,  a  definite  step  forward. 
Thank  you. 

Chairman  Pepper.  Mr.  Perito,  will  you  inquire  ? 
Mr.  Perito.  Secretary  Rossides,  in  1969  the  General  Assembly  of 
Interpol  took  a  position  in  reference  to  this.  What  was  your  position 
at  that  time  representing  the  U.S.  Government  ? 

i\Ir.  Rossides.  We  were  for  a  complete  ban  on  legal  production  of 
opium  worldwide. 

Mr.  Perito.  Is  that  still  the  position  of  the  U.S.  Government  ? 
Mr.  Rossides.  Let  me  qualify  that  to  this  extent :  Yes ;  from  the  en- 
forcement point  of  view  we  were  stating  that  obviously  and  clearly  it 
would  be  of  substantial  help  to  the  enforcement  community — the  var- 
ious police  forces,  the  various  customs  forces  throughout  the  world — 
if  no  legal  production  of  opium  poppy  was  allowed.  That  is  still  the 
position  of  the  Government. 

That  is  not  to  say,  though,  that  there  may  not  be  other  factors  in- 
volved in  the  timing  and  phasing  of  this  proposal.  This  is  the  push 
that  we  would  want.  There  would  be  no  reason  not  to  still  have  that 
position. 

Mr.  Perito.  There  seems  to  me  to  be  some  reluctance  expressed  inso- 
far as  the  codeine  aspect  of  the  ban  was  concerned.  Do  you  have  at 
your  disposal  any  more  additional  facts  medically  which  would  dis- 
abuse some  of  the  people  who  felt  that  we  could  not  move  on  it  insofar 
as  the  synthetics  for  codeine  were  concerned  ? 

Mr.  Rossides.  Well,  it  would  be  the  testimony— and  this  has  to  be 
up  to  the  medical  profession— it  Avould  be  the  testimony  that  this 
committee  has  heard  today.  I  want  to  be  very  clear  in  the  fact  that  as 
a  lawyer  and  as  a  person  with  responsibilities  of  enforcement  at  the 
Department  of  the  Treasury,  and  within  the  administration's  enforce- 
ment community,  we  do  not  try  to  intrude  \ipon  the  medical  judg- 
ment. I  recall,  while  working  on  the  task  force  of  Operation  Inter- 


63 

cept,  thereafter  called  Operation  Cooperation,  we  pinned  down 
the  doctors  and  said  all  right,  what  is  the  harm?  Obviously,  harm 
you  compare  with  the  harm  regarding  heroin,  because  an  estimated 
15  percent  of  heroin  is  grown  illegally  and  produced— from  the 
poppies — in  Mexico  and  converted  to  morphine  and  heroin  and  smug- 
gled in.  But  the  other  operation  of  Intercept  was  regarding  mari- 
huana. 

What  is  the  medical  testimony?  The  medical  evidence?  We  cross- 
examined  them  and  pushed  them  as  this  committee  is  pushing,  and 
rightly  so,  and  they  came  back  with  the  comment  that  there  is  no 
known  good  for  marihuana,  it  can  lead  to  serious  mental  health  prob- 
lems, and  taken  in  conjunction  with  other  drugs  it  can  have  a  more 
serious  effect.  So  we  had  to  base  it  on  the  medical  evidence  and  went 
accordingly.  Research  since  then  has  tended  to  confirm  the  problem 
of  marihuana. 

Getting  back  to  the  specific  point,  that  has  to  be  up  to  the  doctors, 
but  I  concur,  in  listening  to  the  testimony  and  the  chairman's  ques- 
tions and  Mr.  Steiger's  questions,;  that  the  medical  profession  has 
clearly  ^ot  to  move  ahead  and  rapidly.  There  is  no  simple  answer  to 
the  heroin  problem.  It  requires  a  multidimensional  approach. 

I  think  the  President  has  recognized  this  from  the  outset.  This 
committee  has,  and  it  is  moving  ahead  on  many  fronts  in  education 
and  enforcement,  for  example.  If  I  had  a  dollar  to  spend— well,  I 
would  have  spent,  before  these  recent  hearings,  90  percent  on  educa- 
tion, maybe  a  little  less  on  education,  a  little  more  on  research,  but 
enforcement  is  just  one  of  the  elements  in  the  effort. 

I  am  convinced  that  the  youth  have  acquired  great  concern  about 
heroin  and  some  of  the  other  dangerous  drugs.  They  are  not  nearly 
as  convinced  about  marihuana  yet,  but  every  little  bit  helps  and 
every  little  bit  of  pressure  helps,  and  particularly  from  the  Congress. 

Chairman  Pepper.  Mr.  Secretarv,  you  heard  the  testimony  of  Dr. 
Eddy,  and  I  believe  Dr.  Brill.  Both  said  that  heroin  addiction  in  this 
country  is  growing.  We  have  had  testimony  from  the  Bureau  of 
Customs  and  the  Bureau  of  Narcotics  and  Dangerous  Drugs  that  with 
all  of  the  splendid  efforts  they  are  putting  forth  and  the  millions  of 
dollars  of  money  that  Congress  has  made  available  to  you,  the 
hundreds  of  new  agents  that  you  have  been  able  to  put  on  the  job,  yet 
the  problem  is  so  colossal  that  you  are  able  to  seize  only  about  20 
percent  of  the  heroin  coming  into  this  country. 

Now,  here  at  home  we  have  thousands  of  dedicated  law  enforce- 
ment officers  trying  to  stop  the  distribution  of  heroin  in  this  country. 
There  is  no  foreseeable  date,  it  seems  to  me,  when  by  law  enforcement 
alone  we  are  going  to  be  able  to  stop  heroin  from  getting  into  the 
hands  and  the  veins  of  the  addicts  of  this  country. 

Do  you  generally  agree  to  that  ? 

Mr.  RossmES.  The  last  statement  I  agree  to — the  last  part  of  your 
statement,  Mr.  Chairman — that  law  enforcement  alone  cannot  do  the 
job.  That  is  an  absolute  principle  as  far  as  I  am  concerned.  I  cannot 
agree  with  certain  of  the  other  comments  regarding  statistics.  No  one 
fully  knows.  Statistics  in  this  crime  area  are  not  quite  that  reliable 
because  we  don't  have  a  scientific  way  of  gathering  them. 

The  heroin  area  and  crime  is  one  of  the  most  unusual,  because  you 
do  not  have  a  victim  in  the  criminal  sense  as  you  do  when  there  is  a 


64 

bank  robbery  or  an  assault.  You  do  not  have  the  heroin  addict  coming 
forward  and  complaining.  He  is  trying  to  find  where  he  can  get 
some  more  heroin. 

I  do  feel  the  total  effort  which  has  been  made  in  the  last  2  years 
has  stemmed  the  tide.  You  can  feel  it  when  you  are  talking  to  some 
of  the  college  students  and  others.  That  doesn't  mean  we  are  still  not 
in  a  crisis  situation. 

Chairman  Pepper.  You  mean,  sir;  we  are  not  in  a  crisis  situation 
with  respect  to  heroin  use  in  this  country  ? 

Mr.  RossiDEs.  I  said  that  we  are.  We  have  done  an  enormous  amount, 
in  my  judgment,  in  the  combined  Federal  and  State  establishment  in 
the  last  2  years,  and  we  have  arrested  a  downward  slide,  in  my  own 
personal  judgment.  I  get  this  from  many  different  people — from  en- 
forcement people,  from  students,  and  others. 

But  that  doesn't  mean  we  are  not  still  in  a  crisis.  We  are;  obviously 
we  are.  But  it  took  10  years  to  get  to  this  stage  and  the  trip  back  may 
take  a  long  time. 

Chairman  Pepper.  What  we  are  trying  to  do  is  supplement  the 
splendid  effort  you  law  enforcement  people  are  making  by  seeing  if 
it  wouldn't  be  possible  to  stop  the  growing  of  opium.  But  you  have 
to  stop  the  legitimate  demand.  In  order  to  do  that  you  have  to  have 
effective  substitutes, 

Mr.  RossiDES.  From  the  enforcement  point  of  view,  this  is  essential. 

Chairman  Pepper.  That  is  why  I  feel,  and  I  hope  this  belief  is 
shared  by  the  committee,  that  more  money  spent  in  research  to  find 
these  synthetic  substitutes,  and  more  money  spent  in  trying  to  find 
antagonistic  drugs  so  that  the  pusher's  market  would  be  diminished, 
would  help  law  enforcement  in  the  country. 

Mr.  RossiDES.  No  question  whatsoever,  Mr.  Chairman. 

I  used  to  stress  that  out  of  the  dollar  I  would  want  most  of  it  going 
for  education.  I  have  changed  in  the  last  year  to  now  add  the  need 
for  research.  I  do  want  to  point  out  the  President  has  substantially 
increased  funds  for  research  and  education.  But  that  doesn't  mean  more 
may  not  be  needed.  That  is  up  to  the  Congress  and  the  executive  to 
work  out. 

Chairman  Pepper.  Mr.  Blommer  ? 

Mr.  Blommer.  No  ouestions,  Mr.  Chairman. 

Chairman  Pepper.  Mr.  Mann  ? 

Mr.  Mann.  Recognizing  that  the  abolition  of  legal  growing  of  the 
opium  poppy  would  necessarily  be  pursuant  to  an  international  agree- 
ment, almost  worldwide,  what  good  would  it  do  for  the  United  States, 
through  the  Congress,  to  take  unilateral  action  to  abolish  the  importa- 
tion of  opium  ?  What  good  would  it  then  do  you  in  trying  to  negotiate 
an  international  agreement  with  other  countries? 

Mr.  RossiDES.  I  would  say,  without  commenting  fully  on  the  pre- 
mise— because  it  can  be  done  unilaterally  by  each  country 

Mr.  Mann.  Yes. 

Mr.  RossiDES.  (continuing).  The  will  of  the  Congress  spoken  after 
hearings,  after  testimony,  after  review  and  analysis — that  this  is  the 
judgement  of  the  Congress  of  the  United  States,  would  have,  in  my 
judgment,  a  very  salutary  effect  throughout  the  world,  throughout  the 
nations  that  are  members  of  the  TTnited  Nations,  and  it  would  be  a 
plus. 


65 

Mr.  Manist.  But  without  other  sanctions  we  have  merely  cut  off  our 
trading  point  as  far  as  the  control  of  the  market  is  concerned  if  you 
say,  "Well,  we  don't  need  your  poppy  any  more."  Why  should  this 
cause  them  to  stop  growing  it  ? 

Mr.  RossiDES.  When  you  say  sanctions,  you  are  talking  about  nego- 
tiation and  added  factors  are  involved ;  this  is  another  step  in  the  ne- 
gotiation process.  I  think,  for  the  first  time,  the  United  Nations  has 
been  galvanized  to  do  something  following  the  President's  speech  last 
October,  and  our  own  contribution  of  $1  million  out  of  a  $2  million 
pledge.  I  think  other  nations  are  coming  forward.  A  conference  on 
the  revisions  of  the  1961  Single  Convention  on  the  Control  of  Drugs 
is  planned,  hopefully,  for  early  next  year  with  proposals  for  construc- 
tive amendments  bemg  considered. 

Now,  all  of  this  is  helpful.  I  happen  to  feel  that  the  publicity  value 
of  public  opinion,  hearings,  and  of  statements  and  of  positions  are 
helpful.  It  is  no  panacea,  but  it  is  a  step  and  it  is  a  helpful  step. 

Mr.  Mann.  Thank  you 

No  further  questions. 

Chairman  Pepper.  Mr.  Wiggins  ? 

Mr.  Wiggins.  Yes,  sir ;  I  would  like  to  continue  with  the  questions 
started  by  my  colleague,  Mr.  Mann. 

The  United  States  constitutes  a  major  portion  of  the  world  demand 
for  the  lawful  manufacture  of  morphine,  and  accordingly,  if  we  were 
to  stop  our  importation  of  it,  it  would  have  more  than  publicity  impact 
on  those  supplying  countries ;  wouldn't  it  ? 

Mr.  RossiDES.  Yes,  Mr.  Wiggins ;  I  should  have  added  that.  It  cer- 
tainly would.  The  countries  that  are  selling  to  us  would  not  have  the 
market.  So  that  they  would  then  be  possibly  more  inclined  to  look  for 
other  crops. 

Mr.  Wiggins.  We  have  observed  in  Turkey,  for  example,  the  elimi- 
nation of  provinces  where  the  growing  of  poppy  was  permitted  law- 
fully. I  think  we  are  down  to  about  six  or  seven  now,  as  against  a  high 
of  more  than  20  not  too  long  ago. 

Can  you  comment  on  the  enforcement  within  the  nation  of  Turkey 
as  to  the  illicit  growing  of  poppy  in  those  provinces  where  it  has  been 
discontinued  ? 

Mr.  RossiDES.  Yes.  Our  reports  are  that  it  has  been  quite  successful 
in  the  provinces  where  it  has  been  discontinued.  It  was  up  to  21  prov- 
inces and  is  now  down  to  seven.  Reports  that  we  receive  are  that  in 
those  provinces  in  which  growth  has  been  lawfully  discontinued,  en- 
forcement has  been  quite  successful. 

The.  main  growing  areas  are  still  in  the  seven  provinces.  But  at  least 
the  enforcement  effort  has  been  successful  in  the  provinces. 

I  might  conimend  the  Turkish  Government  for  these  efforts,  and 
they  are  devoting  more  manpower  to  this  problem,  and  I  might  quote 
the  new  Turkish  Government's  public  comment  recently  made  by  the 
Prime  Minister,  Mr.  Erim : 

Our  Government  believes  that  opium  smuggling,  which  has  become  a  terrible 
disaster  for  the  youth  of  the  vporld,  is  hurting  above  all  our  humanistic  senti- 
ments :  therefore  due  importance  will  be  attached  to  this  problem.  Opium  pro- 
ducers will  be  provided  with  a  better  way  to  make  a  living. 

That  is  a  step  forward.  Everybody,  including  the  United  States, 
has  to  do  more,  as  this  committee  is  pointing  out. 


66 

Mr.  Wiggins.  Would  the  stopping  of  the  importation  of  lawful 
morphine  into  the  United  States,  in  your  opinion,  tend  to  stimulate 
the  Government  of  Turkey  to  accelerate  its  program  of  cutting  down 
these  provinces  where  the  opium  poppy  is  lawfully  grown  ? 

Mr.  RossiDEs.  I  would  have  to  pass  on  that.  Congressman.  I  would 
have  to  check  with  the  State  Department  and  get  back  to  the  commit- 
tee. I  just  don't  know.  I  am  not  m  a  position  to  know.  (See  exhibit  6.) 

Mr.  Wiggins.  Well,  let  us  suppose  that  there  is  no  more  lawful  opium 
poppy  grown  in  Turkey.  What  impact  would  that  have  on  organized 
criminal  activities  in  the  United  States  ? 

Mr.  RossiDEs.  Well,  the  impact  would  be  significant,  in  my  judg- 
ment, and  they  would  look  to  other  sources,  Southeast  Asia,  other 
possibilities  in  the  Near  and  Middle  East.  But  clearly  you  have  made 
a  major  advance  because  you  have  disrupted  a  known  pattern  of 
trade,  of  illegal  activity. 

One  of  the  things  that  we  are  doing,  we  are  making  strenuous 
efforts  to  analyze,  review  and  do  something  about  the  situation  in 
Southeast  Asia,  even  though  the  percentage,  we  estimate  that  the  per- 
centage of  opium  coming  from  there  is  quite  small.  There  is  an  enor- 
mous amount  grown  in  Burma  and  Thailand,  and  most  of  it  is  used 
in  the  area,  but  we  are  trying  now  for  the  first  time  to  be  ahead  of 
the  game  instead  of  our  just  reacting.  In  fact,  the  organized  criminals 
are  not  going  to  stop  when  they  see  a  profit.  We  have  to  have  a  total 
fight.  It  has  to  include  enforcement,  education,  research;  every  possi- 
ble way. 

As  I  say,  I  think  we  have  done  a  good  job.  I  really  do.  But  more 

["» Q  o  "t  c\  hf*  ri  on  (^ 

Mr.  Wiggins.  It  is  generally  known  that  the  largest  opium  pro- 
ducers in  the  world  are  India  and  the  Soviet  Union  with  Turkey 
third.  It  is  usually  stated,  however,  that  there  is  minimal  diversion 
from  India  and  from  the  Soviet  Union. 

Do  you  think  if  we  were  to  ban  the  lawful  importation  of  morphine 
that  we  run  the  risk  of  development  of  an  illicit  market  in  these  two 
areas  ? 

Mr.  RossiDES.  I  do  not. 

Mr.  Wiggins.  Well,  now  let's  turn  to  Mexico.  Usually  the  figure  is 
5  to  15  percent,  something  of  that  range,  is  attributed  to  Mexico  as  a 
source  of  heroin.  It  is  not  grown  lawfully  in  Mexico  at  all.  Mexico  is 
not  one  of  the — what  is  it,  seven — countries  that  may  lawfully  grow 
poppies  ? 

Mr.  RossiDES.  Correct. 

Mr.  Wiggins.  What  impact  do  you  think  it  would  have,  if  any,  in 
Mexico  ? 

Mr.  RossiDES.  None — no  real  impact  in  Mexico — because  it  is  already 
illegal  there  as  is  the  growing  of  hemp.  The  problem  in  IVIexico  is  that 
the  growth  is  in  the  mountains — very  difficult  areas  to  detect — and  in- 
accessible areas  where  it  is  quite  difficult  to  prevent  the  growth.  The 
Mexican  Government,  however,  has  made  many  strenuous  efforts  and 
has  had  some  success.  But  a  great  deal  more  needs  to  be  done  and  is 
being  done. 

We  have  just  concluded  the  fourth  or  fifth  meeting  with  our  col- 
leagues from  Mexico,  and  I  commend  the  efforfs  of  the  Mexican  Gov- 
ernment and  the  public  condemnation  by  the  Mexican  Government  of 


67 

the  traffickin<2:  in  heroin  and  marihuana.  They  are  doinji:  better.  Again, 
it  is  an  intei-national  problem.  We  cannot  be  satisfied.  We  cannot  say 
that  anyone  is  doing  adequately,  except  maybe  Japan,  which  took  care 
of  the  lieroin  problem  by  tlie  strictest  kind  of  enforcement,  moral  and 
cultural,  and  public  effort.  Every  one  of  the  policemen  in  Tokyo  is  a 
narcotics  expert,  and  with  their  tough  customs  efforts,  Japan  has  done 
the  job.  What  I  am  saying  is  that  I  don't  want  to  point  a  finger  at  any 
one  country,  because  we  are  all  guilty.  But  no  matter  how  much  more 
we  are  doing,  we  are  not  nearly  at  the  point  Avhere  we  can  even  think 
of  seeing  the  end  of  the  road,  and  we  are  just  going  to  have  to  redouble 
our  efforts. 

Mr.  WiGGixs.  I  would  like  to  conclude,  Mr.  Chairman,  with  just  a 
brief  comment. 

I  don't  think  any  of  us  have  ever  felt  that  the  prohibition  against 
the  importation  of  morphine  in  this  country  would  be  in  and  of  itself 
a  panacea.  But  there  are  many  incidental  fallout  benefits  for  doing  so. 
One  of  them  is  the  disruption  of  the  organized  criminal  infrastructure 
involved  in  the  importation  of  heroin  in  this  country.  It  took  many, 
many  years  to  develop  the  chain  from  Turkey  into  the  Port  of  New 
York.  That  in  and  of  itself  is  a  substantial  achievement. 

Chairman  Pepper.  If  you  Avill  excuse  me  just  a  minute,  while  you 
are  on  that  subject,  there  are  two  things  I  want  to  ask  the  Secretary. 

One  is,  can  you  tell  us  what  is  the  extent  of  the  involvement  as  you 
have  found  it  of  what  we  call  organized  crime  in  the  importation  of 
heroin  into  the  United  States  ?  How  deeply  is  organized  crime  involved 
in  the  importation  of  heroin  ? 

Mr.  RossroES.  Mr.  Chairman,  practically  every  bit  of  heroin  brought 
into  the  United  States  is  brought  into  the  United  States  by  organized 
crime.  The  heroin  traffic  is  a  highly  organized  criminal  conspiracy. 

Now,  what  is  the  definition  of  organized  crime  ?  That  is  where  peo- 
ple may  disagree.  My  first  law  enforcement  came  while  working  under 
Mr.  Hogan,  probably  the  greatest  district  attorney  that  the  Nation  has 
had.  He  would  never  allow  his  assistants  to  use  the  word  "Mafia,"  be- 
cause it  gave  the  false  impression  that  the  Mafia  was  the  only  part  of 
organized  crime. 

Organized  crime  is  a  criminal  conspiracy  of  a  continuing  nature,  I 
would  say  this,  that  there  have  been  more  members  of  certain  of  the 
IVIafia  families  involved  before — probably  less  now — but  the  groups 
that  are  involved  now  in  the  heroin  traffic  are  of  all  ethnic  groups,  all 
religious  groups,  and  all  racial  groups.  The  key  groups  outside  the 
country  are  the  French  Corsicans.  Certain  of  the  families — the  Mafia 
families — are  still  involved  at  the  importation  level.  They  take  their 
cut  on  getting  it  in.  They  do  not  have,  as  they  do  in  their  other  enter- 
prises, the  distribution  system  up  and  down  the  line.  In  gambling,  for 
instance,  they  will  take  care  of  someone  that  is  pulled  in,  provide  him 
with  counsel  and  take  care  of  the  family.  That  is  not  necessarily  the 
problem  here. 

You  have  a  different  distribution  system.  It  is  in  the  ghetto.  The 
blacks  are  profiting  from  it,  the  Puerto  Ricans,  ethnic,  Irish,  Italian, 
Greek,  every  group. 

My  only  point  is  that  organized  crime  is  involved,  but  we  cloud  the 
issue  when  we  try  to  equate  organized  crime  with  the  Mafia. 

My  point  is  that  organized  crime  is  far  broader. 


68 

Chairman  Pepper.  Can  you  give  us  an  estimate  as  to  the  number  of 
people  who  make  up  that  organized  crime  group  responsible  for  the 
importation  of  heroin  into  this  country  ? 

Mr.  EossroES.  I  would  not  have  that  at  my  fingertips,  nor  would  we 
have  a  firm  figure  of  the  number  of  persons  involved. 

Let  me  review  that  with  my  staff,  Mr.  Chairman,  and  try  to  supply 
the  committee  with  an  estimate  of  the  number  of  persons  that  you 
are  talking  about. 

Chairman  Pepper.  We  would  appreciate  it  if  you  would  get  us 
that  information. 

The  reason  I  ask  particularly  is  because  Mr.  William  Tendy,  for- 
merly of  the  U.S.  attorney's  office  in  Xew  York,  told  our  committee 
that,  as  I  recall  it,  10  to  15  organized  crime  figures  were  responsible 
for  most  of  the  heroin  smuggled  into  the  United  States. 

Mr.  Rossides.  I  believe  they  meant  syndicates.  I  would  agree  with 
that  figure.  I  would  agree  you  are  talking  about  probably  up  to  15 
at  a  maximum  of  significant  criminal  conspiracies,  of  organized  crime, 
of  all  types,  natures,  and  backgrounds. 

Chairman  Pepper.  One  other  question.  Do  you  have  any  estimate  or 
could  you  get  us  one  as  to  how  much  all  the  growers  of  the  opium 
poppy  in  the  world — I  mean,  growing  it  in  any  appreciable  quantity — 
are  making  from  that  production. 

Mr.  Rossides.  I  don't  have  it  now.  I  will  try  and  supply  it,  Mr. 
Chairman. 

(The  information  requested  was  not  available  at  time  of  printing.) 

Chairman  Pepper.  If  we  and  others  working  with  us  were  to  give 
every  opium  poppy  grower  in  the  world  the  same  amount  of  income 
that  he  is  now  deriving  from  the  growth  of  the  opium  poppy,  how  much 
would  it  cost  the  participating  nations  in  such  a  program  ? 

Mr.  Rossides.  I  will  try  and  find  out,  Mr.  Chairman,  but  I  would 
like  to  go  on  record  as  strongly  opposed  to  any  concept  of  preemptive 
buying.  It  would  simply  stimulate  production  and  it  would  take  away 
the  responsiblity  of  each  nation  to  handle  the  problem  as  part  oP  the 
international  community.  I  just  want  to  make  sure  of  that. 

Chairman  Pepper.  I  don't  think  anybody  on  this  committee  would 
follow  that  will-o-the-wisp  of  wanting  to  start  the  United  States  in 
buying  all  the  opium  production  in  the  world.  I  am  not  talking  about 
that. 

I  am  talking  about  if  you  got  them  to  grow  soybeans,  wheat,  or 
something  else,  if  they  had  the  guarantee  of  the  same  income  from  the 
growing  of  legitimate  products,  how  much  would  the  financial  burden 
be  upon  the  nations  including  the  nation  where  the  growing  occurs  ? 

Mr.  Rossides.  I  would  answer  that.  I  will  find  out  the  figure,  if  it 
is  available.  There  would  be  no  financial  burden  because  what  you 
would  be  doing  is  substituting  a  crop.  So  really  you  would  be  making 
an  investment,  a  capital  investment  for  the  group. 

Chairman  Pepper.  Yes. 

(The  information  requested  was  not  available  at  time  of  printing.) 

Chairman  Pepper.  Mr.  Steiger? 

Mr.  Steiger? 

Mr.  Steiger.  I  yield  to  Mr.  Wiggins. 

Mr.  Wiggins.  I  have  just  one  more  question,  Mr.  Rossides.  There  is 
the  possibility  that  if  effective  synthetics  are  mandatory  in  this  coun- 
try that  they  in  turn  would  be  widely  abused  and  diverted.  Let's  sup- 
pose that  happens.  Has  your  experience  indicated  that  the  organized 


69 

criminal  groups  within  this  country  have  been  in  the  business  of  di- 
verting amphetamines,  for  example? 

Mr.  RossiDES.  Oh,  yes. 

Mr.  Wiggins.  Do  we  change  the  nature  of  the  enemy  in  any  way  ? 
I  would  like  you  to  comment  on  the  ease  or  difficulty  of  controlling 
diversion  from  lawful  manufacturers  in  the  United  States  as  dis- 
tinguished from  lawful  producers  of  natural  poppy  elsewhere. 

Mr.  RossiDES.  I  would  refer  the  diversion  problem  to  the  Bureau  of 
Narcotics  and  Dangerous  Drugs,  which  has  the  responsibility  for  pre- 
venting illegal  distribution  of  dangerous  drugs.  (See  testimony  of 
John  Ingersoll,  Director,  BNDD,  on  Jmie  2,  1971.) 

There  is  no  question  that  there  are  efforts  by  organized  crime  to 
steal  the  pills,  and  one  of  the  reasons  for  the  Drug  Abuse  Act  of  1970 
was  that  before  there  were  not  the  proper  controls  on  the  manufacture 
and  distribution  in  following  production  down  the  line  so  that  you  had 
a  controlled  system.  It  was  a  simple  thing  to  sell  a  million  pills  to  a 
post  office  box  number  in  Tijuana  and  then  smuggle  them  back  into 
the  United  States.  It  was  really  very  simple. 

My  own  feeling  is  if  we  are  able  to  be  more  successful  in  stopping 
heroin  from  coming  in,  organized  crime  would  naturally  try  to  divert 
to  dealing  in  pills.  But  again  it  is  a  manageable  problem.  It  is  some- 
thing we  are  trying  to  do  in  the  area  of  cargo  theft.  It  is  not  that 
difficult  to  develop  a  system  at  the  ports  of  entry. 

Mr.  Wiggins.  Is  it  more  manageable  than  the  difficulty  you  are 
experiencing  in  preventing  the  importation  of  heroin  ? 

Mr.  RossiDES.  I  haven't  looked  at  it  enough.  In  my  judgment  it 
would  be.  But  you  have  got  to  remember  that  a  lot  of  pills  are  pro- 
duced. I  hadn't  thought  of  the  comparison  of  the  problem,  but  it  is 
not — let  me  put  it  a  different  way.  I  would  rather  face  the  problem 
of  increased  effort  to  divert  the  pills  that  would  come  from  a  sucess- 
ful  effort  to  prevent  the  heroin  being  smuggled  into  the  United  States, 
I  think  that  is  far  more  manageable  and  we  can  move  in  that  area  by 
careful  controls  by  the  manufacturers  themselves  in  many  ways. 

Chairman  Pepper.  Mr.  Steiger  ? 

Mr.  Steiger.  Yes,  Mr.  Chairman. 

Mr.  Secretary,  you  have  been  very  candid,  and  I  appreciate  it.  In 
your  relations  with  Interpol  and  with  other  enforcement  people  from 
these  other  countries,  as  a  cold,  practical  matter  if  there  were  to  be — 
somehow  we  could  achieve  international  agreement  that  would  ban 
the  poppy,  how  rigid  do  you  think  the  internal  enforcement  would  be, 
say,  in  Turkey,  and  I  might  add  that  the  seven  privinces  which  now 
produce,  which  Turkey  has  reduced  the  legality  of  the  poppy,  it  is 
my  understanding  and  you  indicated  the  same  thing,  that  still  had 
about  90  percent  of  the  existing  poppy  production.  So  it  really  sounds 
good  to  go  from  20  to  seven,  but  we  haven't  reduced  the  production 
by  30  percent. 

In  those  areas  of  five  or  10  poppy  producers,  as  a  practical,  political 
matter,  how  tough  would  their  enforcement  be  ? 

Mr.  RossiDES.  Well,  even  on  the  question — if  it  were  made  illegal  ? 

Mr.  Steiger.  Yes ;  how  tough  would  the  Turkish  police  be  on  their 
people  ? 

Mr.  RossiDES.  I  think  we  have  to  commend  the  new  Turkish  Gov- 
ernment for  its  forthright  statement.  The  first  time  that  a  public 
statement  has  been  made,  and  I  do  commend  them  for  that. 


70 

The  problem  then  would  be  the  will  of  the  Government  of  Tur- 
key, and  I  am  convinced  that  they  would  be  able  to  handle  it. 

Mr,  Steiger.  Well,  of  course,  you  know,  we  talk  about  preempted 
buying.  One  area  this  country  has  expertise  in  is  in  paying  people  not 
to  grow  things.  We  have  a  great,  long  history  of  that.  I  am  con- 
vinced, as  apparently  the  chairman  is,  that  we  could  produce  a  viable 
plan  in  which  we  could  augment  the  poppy  growers'  income  to  the 
point  where  he  wouldn't  have  to  grow  poppies  at  a  fraction 

Mr.  KossiDES.  Crop  substitution  is  the  answer.  I  don't  consider  that 
to  be  preemptive  buying. 

Mr.  Steiger.  But  we  are  dealing  with  a  very  real  problem  as  we  un- 
derstand it,  the  guy  wants  to  grow  poppies,  he  has  grown  poppies 
forever,  and  his  folks  before  him,  and  that  is  something  a  little  tough 
for  us  to  understand.  I  am  asking  you  how  valid  is  this  desire  to  grow 
poppies  on  the  part  of  the  seven  Turkish  provinces  and  how  emo- 
tional an  issue  is  it  within  those  provinces. 

Mr.  RossiDES.  I  would  pass  and  let  the  State  Department  come  up 
with  the  analysis  of  the  psychology  of  the  Turkish  farmer. 

(The  analysis  referred  to  above  follows :) 

[Exhibit  No.  6] 

Department  of  State. 
Washington,  B.C.,  July  2,  1971. 
Hon.  Claude  Peppeb, 
Chairman,  Select  Committee  on  Crime, 
House  of  Representatives. 

Dexar  Mr.  Chairman  :  I  refer  to  your  letter  of  May  27,  requesting  informa- 
tion about  Turkey  and  opium. 

As  you  may  know,  on  June  30  that  country's  government  showed  a  strong 
sense  of  international  responsibility  in  taking  the  diflBcult  decision  to  ban  further 
opium  cultivation  to  be  effective  approximately  1  year  from  now.  Under  Turkish 
law  farmers  must  be  given  1  year's  notice  before  opium  poppy  planting  can 
be  prohibited  in  areas  where  cultivation  has  been  permitted.  Nonetheless,  in 
his  statement  explaining  the  opium  ban,  the  Prime  Minister  has  said  that  he 
wU  take  every  measure  to  eliminate  smuggling  and  he  will  undertake  a  program 
to  induce  farmers,  who  are  legally  permitted  to  plant  in  the  fall  of  1971.  to 
voluntarily  abstain  from  planting.  Beginning  in  the  fall  of  1972  opium  poppy 
will  be  banned  throughout  Turkey. 

We  have  also  been  encouraged  by  other  recent  evidence  of  the  Turkish 
Government's  intention  to  prevent  Turkish  opium  from  entering  illicit  channels. 
On  June  18,  a  strict  opium  licensing  and  control  bill  was  reported  out  of  com- 
mittee; it  was  passed  by  the  National  Assembly  of  the  Parliament  on  June  21. 
The  bill  is  now  under  consideration  in  the  Turkish  Senate.  We  anticipate  that 
the  legislation  will  pass  before  the  end  of  the  session,  now  scheduled  for  July  30. 

In  addition,  measures  which  the  Turkish  Government  has  taken  to  insure 
collection  of  the  total  production  from  this  year's  harvest  will  result,  we 
believe,  in  a  much  improved  performance.  Among  these  new  measures  are : 
training  of  additional  agents ;  an  increase  in  the  purchase  price  of  the  opiiuu 
gum ;  provision  for  advance  cash  payments  to  the  farmers ;  collection  of  the 
gum  at  the  farm  immediately  after  harvest;  and  improved  coordination  of 
tlie  elements  involved  in  the  collection.  Moreover,  enforcement  efforts  arc  also 
showing  improved  results. 

The  amount  of  opiates  seized  during  tlie  first  4  montlis  of  1971  (equivalent 
to  574  pounds  of  pure  heroin,  which  would  have  been  worth  about  $00  million 
in  the  IJ.S.  market)  is  more  than  double  that  seized  during  the  entire  year  of 
1970.  It  is  also  more  than  the  total  amount  seized  by  U.S.  enforcement  agencies 
within  the  United  States  and  at  our  borders  during  these  same  4  months. 

With  regard  to  substitute  crops,  none  have  been  identified  tliat  can  replace 
opmm  pQppy  in  all  the  provinces  where  it  is  grown.  Tlie  Turkish  Ministry  of 
Agriculture  is  conducting  research  into  this  problem  witli  assistance  provided 
under  an  AID  loan.  However,  agricultural  research  by   its  very   nature  is  a 


71 

slow  prcx?ess.  Some  possible  alternative  crops  have  been  identified  and  further 
investigations  are  being  conducted.  The  Turkish  Agricultural  Extension  Service 
is  working  with  farmers  in  those  areas  where  production  has  been  banned  teach- 
ing the  farmers  ways  of  increasing  their  yields  of  such  crops  as  sunflower  seeds, 
vetch,  various  fruits  and  vegetables  and  new  varieties  of  wheat. 

Prime  Minister  Erim  recognized  that  the  cost  and  diflBculties  of  controlling 
opium  cultivation  were  greater  than  the  economic  importance  it  has  for  the 
Anatolian  farmer,  great  as  that  is.  His  courageous  and  statemanlike  action 
will  greatly  help  to  reduce  and  to  disrupt  the  existing  pattern  of  illicit  inter- 
national traflBcking,  and  it  will  provide  an  example  for  other  countries.  I  en- 
close a  translaton  of  Prime  Minister  Erim's  statement  explaining  his  Govern- 
ment's reasons  for  terminating  opium  production  and  a  copy  of  the  Turkish 
Government's  decree. 

I  hope  this  information  will  be  helpful.  Please  do  not  hesitate  to  call  on  us 
when  ever  you  feel  we  might  be  of  assistance. 
Sincerely  yours, 

David  M.  Abshire, 
Assistant  Secretary  for 
Congressional  Relations. 
(Enclosure  1) 

Statement  of  Prime  Minister  Erim. — June  30,  1971 

In  recent  years  the  abuse  of  narcotics  in  the  world  has  assumed  a  very  seri- 
ous and  dangerous  condition.  This  situation  has  been  described  by  the  United 
Nations  as  almost  an  "exp'osion."  Several  times  more  production  is  made  of 
narcotic  drugs  than  is  needed  for  legitimate  and  medical  needs.  For  this  reason, 
the  lives  of  millions  of  persons  who  use  narcotics  end.  In  some  countries,  this 
deadly  disaster  is  spreading  rapidly,  particularly  among  youth.  It  is  noted  that 
even  12-year-old  children  are  drawn  to  drugs.  Countries  which  never  used  drugs 
10  years  ago  are  now  its  victim.  The  tragedy  has  spread  even  as  far  as  the 
African  countries.  Furthermore,  addiction  has  begun  to  threaten  all  the  mem- 
bers of  the  community.  Youth  in  particular  must  be  protected  from  this  addiction 
as  a  great  duty  for  the  sake  of  mankind. 

We  have  seen  what  a  great  danger  the  world  is  facing.  We  touched  on  this  in 
the  Govenment  program  which  our  Parliament  passed :  "And  indicated  that 
the  problem  of  opium  smuggling,  which  has  become  a  destructive  tragedy  for 
all  young  people  in  the  world,  will  be  seriously  undertaken  by  the  Government, 
which  believes  before  all  else  that  this  harms  sentiments  of  humane  considera- 
tion. Opium  growers  will  be  given  support  by  showing  them  a  better  field  for 
earning  their  living." 

Indeed.  Turkey  has  not  remained  a  stranger  to  the  development  of  the  prob- 
lem of  narcotic  drugs,  to  the  international  agreements  made  in  this  matter  since 
the  beginning  of  the  20th  century,  and  to  the  work  of  the  United  Nations.  On 
the  contrary,  she  has  joined  in  the  agreements  and  has  taken  decisions  to  end 
this  disaster. 

Turkey  has  participated  in  all  the  international  agreements  made  on  the  sub- 
ject of  narcotics  beginning  with  the  Hague  Agreement  of  1912 ;  those  concluded 
agreements  in  1925,  1931,  1936,  1946.  1948,  1953  and  1961. 

An  important  provision  of  the  1961  Narcotics  Single  Convention,  signed  by  78 
nations,  is  the  article  which  binds  the  production  of  opium  to  the  permission 
of  the  Government. 

Governments  coming  before  us  have  fulfilled  their  commitments  to  interna- 
tional agreements  and  furnished  all  types  of  statistical  information  to  the 
authorized  organs  of  the  U.N.  However,  the  need  law  establishing  a  licensing  sys- 
tem for  planting  in  Turkey,  which  is  the  key  point  of  this  agreement,  for  some 
reason  was  not  passed  until  this  year.  Our  state  was  continuously  asked  by  inter- 
nationally authorized  organs  to  fulfill  this  commitment.  This  shortcoming  was 
criticized  in  the  parliaments  of  many  countries  and  by  their  public  opinion.  The 
U.N.  Secretary  General  in  the  report  he  presented  on  this  subject  in  1970,  based 
on  these  criticisms,  said  that  an  extensive  amount  of  smuggling  was  being  made 
from  Turkey. 

After  this,  matters  took  a  rapid  turn.  In  the  summer  of  last  year  the  matter 
was  first  taken  up  at  the  U.N.  Economic  and  Social  Committee.  The  Committee 
on  Narcotic  Drugs  was  called  to  an  extraordinary  meeting.  There,  the  critical 
situation  in  the  world  was  taken  up  and  it  was  decided  to  start  a  struggle  by 


72 

taking  exceptional  measures  in  the  three  stages  of  the  problem :  Production, 
supply  and  demand,  and  smuggling.  It  was  stipulated  that  a  fund  was  to  be 
established  to  assure  the  financial  means  for  this  purpose.  The  subject  was  agreed 
upon  at  the  General  Council  meeting  of  the  U.N.  too. 

In  a  law  passed  by  the  Turkish  Grand  National  Assembly  in  1966,  Turkey 
ratified  the  international  agreement  signed  in  1961.  In  this  way,  international 
commitments  became  a  part  of  our  national  law.  Accordingly,  "In  the  event 
one  of  the  parties  fails  to  implement  the  provisions  of  the  agreement  and  through 
this,  the  object  of  the  agreement  is  seriously  harmed,  the  control  body  will  ask 
that  the  situatiotrbe  corrected  and  can  go  so  far  as  to  set  up  an  embargo  against 
this  country. 

Smuggling  made  from  our  country  in  recent  years  has  become  very  distressing 
for  us.  Governments,  whicli  were  unable  to  prevent  smuggling,  decreased  the 
number  of  provinces  where  poppies  were  planted  from  1960  on  and  gradually 
moved  to  the  planting  of  opium  from  regions  close  to  the  border  to  the  center 
of  Anatolia.  Now  planting  has  been  decreased  to  four  provinces.  In  this  way  it  was 
hoped  to  prevent  smuggling. 

However,  imfortunately,  this  system  did  not  give  results.  During  1970  many 
things  developed  in  favor  of  the  smugglers.  Although  the  soil  products  oflSce 
obtained  116  tons  of  opium  from  the  poppies  planted  in  11  provinces  in  1969, 
in  1970  the  opium  which  reached  the  oflSce  from  nine  pro\ances  was  only  60  tons. 

The  whole  world  is  asking  where  the  difference  is  going.  The  contraband  opium 
seized  by  our  security  forces,  which  we  learn  about  in  radio  and  newspaper 
reports,  shows  everyone  the  extent  of  the  problem. 

It  is  certain  that  a  smugglers'  gang  organized  on  an  international  scale,  consti- 
tutes a  political  and  economic  problem  for  Turkey.  They  will  not  be  i^ermitted  to 
play  around  with  the  prestige  of  our  country  any  further. 

This  horrible  network  of  smugglers  fools  our  villagers  either  with  the  wish 
to  make  extra  money  or  by  force  and  it  tries  to  use  them  for  their  own  ends. 
Of  the  tremendous  sums  which  revolve  around  these  transactions,  the  poor 
hard-working  Turkish  villager  actually  does  not  get  much.  The  smugglers  pay 
400  or  500  liras  for  an  illegal  kilo  of  opium  to  the  villagers  whom  they  force  to 
break  the  law.  By  the  time  this  opium  reaches  Turkey's  borders,  the  smugglers 
have  made  a  profit  many  times  multiplied.  After  it  leaves  our  country  and 
throughout  its  route,  the  value  of  the  drug  becomes  augmented  more  and  more ; 
in  the  end  it  reaches  an  unbelievable  price.  International  smugglers  are  earning 
millions  from  the  raw  opium  produced  by  the  villagers,  but  the  Turkish  farmer 
gets  only  a  paltry  sum.  In  countries  where  health  is  endangered  through  this 
opium,  because  smuggling  cannot  be  prevented  in  Turkey,  anti-Turkish  opinions 
are  created. 

The  Turkish  villager  also  naturally  feels  bitter  against  this  problem  created 
by  the  smugglers  who  make  millions  from  the  back  of  our  farmers.  All  I'urkish 
citizens  also  feel  a  moral  pain  that  our  country  is  blamed  for  smuggling  which 
is  poisoning  world  youth. 

The  measures  to  be  applied  to  control  smuggling  are  extremely  expensive.  In 
general,  poppies  are  planted  in  one  corner  of  the  field.  For  this  reason,  it  is 
necessary  to  establish  an  organization  which  can  control  an  area  10  times  that 
of  a  total  poppy  farming  area  of  13,000  donums  which  may  actually  be  planted. 
Vehicles,  gasoline,  personnel  and  their  salaries  must  not  be  forgotten.  Smugglers 
on  the  other  hand,  it  must  be  remembered,  will  resort  to  any  means.  Until  now, 
foreign  assistance  was  obtained  for  control  purposes;  even  an  airplane  was 
obtained  for  our  organization.  But,  unfortunately,  the  matter  was  imiK>ssible  to 
control  by  these  means,  in  spite  of  all  the  efforts  which  were  made.  Our  nation, 
which  is  known  for  its  honesty  and  integrity,  is  now  under  a  grave  accusation. 
The  time  when  we  must  end  the  placing  of  blame  for  deaths  in  other  countries 
on  T'nri.-aT-  is  lori"'  ovptIik^. 

We  cannot  allow  Turkey's  supreme  interests  and  the  prestige  of  our  nation 
to  be  further  shaken.  Our  government  has  decided  to  apply  a  clear  and  firm 
solutioii.  ii  forbids  completely  the  planting  of  poppies;  they  have  already  been 
reduced  to  four  provinces.  The  agreement  ratified  in  1966  also  stipulates  this 
arrangement. 

Poppies  will  not  be  planted  in  Turkey  beginning  next  year.  However,  we  have 
given  careful  consideration  to  the  fact  that  the  farmers  have  until  now  obtained 
a  legitimate  and  additional  source  of  income  from  the  phinting  of  ix>ppies.  For 
this  reason,  in  order  that  the  poppy  growers  will  not  incur  a  loss  in  any  way,  the 
necessary  formula  has  been  developed.  This  formula  is:    in  order  to  make  up 


73 

for  the  income  farmers  who  are  planting  in  provinces  at  present  will  lose,  they 
will  be  given  compensation  beginning  from  the  coming  year.  This  compensation 
will  work  this  way :  the  basis  will  be  the  value  on  the  international  market 
of  the  whole  produce,  such  as  opium,  seeds,  stems,  etc.,  that  the  planters  will  sell 
to  the  soil  products  office  this  year. 

Furthermore,  in  order  to  replace  the  income  lost  by  farmers  by  other  means, 
and  to  provide  them  other  means  or  earning  a  living,  long-term  investments  will 
be  made  in  the  region.  Until  these  investments  give  fruit,  villagers  will  continue 
to  be  given  comi>ensation.  From  among  those  who  would  normally  plant  this 
year,  those  who  voluntarily  give  up  planting  in  the  coming  Autumn  will  be  given 
compensation  on  the  same  basis. 

I  am  now  addressing  my  villager  citizens,  in  order  that  this  plan  may  be 
successful  and  that  it  will  be  possible  to  establish  real  values  for  future  year 
compensations  and  the  criteria  for  investment,  please  turn  over  all  your  produce 
to  the  Soil  Products  Office.  You  will  receive  the  necessary  assistance  in  this 
respect  We  have  also  raised  our  purchasing  price.  The  larger  the  amount  turned 
over  to  the  office  by  all  the  poppy  producers,  the  larger  the  compensation  they 
will  receive  in  the  coming  years  without  planting.  Bes(ide.s,  by  selling  all  his 
produce  to  the  TMO,  the  producer  will  prove  he  is  not  the  tool  of  the  smuggler, 
that  the  Turkish  farmer  at  no  time  had  the  object  of  poisoning  the  whole  world, 
nor  that  he  encouraged  this  knowingly.  Dear  Farmer  Citizens,  you  will  be  the 
ones  to  save  the  prestige  of  our  nation.  The  Government  will  also  henceforth 
give  special  importance  to  your  problems.  Our  Government  has  taken  precau- 
tions in  order  that,  in  the  end.  not  a  siingle  farmer  family  will  incur  a  loss.  Your 
income  will  be  met  without  allowing  any  room  for  doubts;  at  the  same  time, 
it  is  planned  to  establish  necessary  installations  to  open  new  sources  of  income 
in  the  region.  I  ask  you  to  carry  out  this  plan  and  to  .sell  all  your  opium  products 
for  this  year  to  the  Office  at  the  high  price  established  last  month,  thereby  you 
will  give  this  program  a  good  start. 

(Enclosure  2) 

Turkish  Opitjm  Decree,  June  30,  1971 

On  the  basis  of  the  letter  of  the  Ministry  of  Agriculture  dated  June  26,  1971, 
No.  02-16/1-01/342 ;  per  law  3491  as  amended  by  law  7368,  article  18 ;  and  per 
article  22  of  appendix  agreement  dated  December  27,  1966,  to  law  812,  the 
Council  of  Ministers  has  decided  on  June  30,  1971 :  Definitely  to  forbid  the 
planting  and  production  of  poppies  within  the  borders  of  Turkey  beginning 
from  the  autimm  of  1972.  This  Will  be  done  by  specifying  the  provinces  shown 
on  the  lists  attached  hereto. 

1.  To  forbid  poppy  planting  and  opium  producing  in  provinces  where  warning 
is  given  as  of  the  autumn  of  1972 — Afyon,  Burdur,  Isparta,  Kutahya. 

2.  To  forbid  popipy  planting  and  opium  producing  in  the  provinces  where  a 
warning  has  been  g*iven  from  the  autumn  of  1971 — Denizli,  Konya,  Usak. 

3.  To  give  a  suitable  compensation  as  proposed  by  the  Ministry  of  Agriculture 
and  by  decision  of  the  Council  of  Ministers  to  the  planters  in  these  seven  prov- 
inces where  poppy  planting  and  production  have  been  forbidden.  This  Will  be 
on  the  basis  of  the  opium  they  deliver  this  year  to  the  Soil  Products  Office  and 
on  the  ba.sis  of  other  poppy  byproducts  so  that  the  farmers  will  not  incur  any 
loss  of  income. 

4.  To  grant  to  the  planters  in  the  areas  indicated  in  paragraph  1,  who  volun- 
tar'ily  give  up  planting  in  the  autumn  of  1971,  the  right  to  benefit  from  the 
compensation  set  forth  in  paragraph  3. 

C.   SUNAY, 

President  of  the  Republic. 

Mr.  RossiDES.  But  I  only  IPass  in  a  sense.  I  don't  want  to  duck  any 
question,  because  I  keep  coming  back  to  what  I  think  was  a  tremendous 
statement  by  the  new  Government  of  Turkey,  which  I  think  they 
should  be  commended  for.  The  Prime  Minister's  statement,  Mr.  Erim's 
statement,  to  the  effect  that  the  contraband  trade  in  opium,  which  has 
assumed  the  aspect  of  ovei- whelming  blight  for  the  youth  of  the  whole 
world,  is  offensive  on  humanitarian  grounds.  The  Government  will 

60-206  O— 71— pt.  1 6 


74 

pay  serious  attention  to  this  problem.  Turkey's  opium  growers  "will 
be  shown  a  way  to  earn  a  better  living. 

We  should  commend  the  Turkish  Government  for  this  statement. 
I  know  what  you  are  saying.  The  tradition  of  hundreds  of  years 
and 

Mr.  SteiCxER.  My  only  point  in  this  whole  line  of  questioning.  Mr. 
Secretary,  and  you  obviously  realize  it,  but  I  think  it  is  important  that 
we  understand  it,  as  I  think  we  do,  is  that  it  is  obviously  a  positive 
step,  it  is  obviously  appropriate,  but  we  mustn't  be  deluded  into  think- 
ing it  is  any  kind  of  panacea  and  actually  the  difficulties  that  you  are 
now  experiencing  will  not  be  alleviated  completely.  There  will  still  be 
attempts  made  by  this  organized  crime  organization  if  they  have  to  go 
somewhere  else.  It  took  them  a  long  time  to  work  up  their  Turkish- 
American  lines,  but  they  now  know  how  to  do  it  and  there  are  lots  of 
places  they  can  go,  as  you  indicated,  and  as  Mr.  Wiggins  replied,  there 
is  a  question  about  Mexico. 

I  think  it  might  be  worthwhile  if  you  could  help  the  committee  in 
finding  out  what  the  Japanese  customs  did,  for  example,  that  enabled — 
aside  from  the  educational  program  they  went  through  as  described — 
what  actual 

Mr.  RossiDES.  Correct.  I  will  be  happy  to  submit  a  statement  that 
the  committee  would  hopefully  consider  whether  it  wanted  to  include 
it  as  part  of  the  record.  I  was  not  aware  of  the  enormous  success  of  the 
Japanese  until  last  year.  It  was  a  total  effort  by  the  Government  and 
was  effective  as  a  result  of  their  cultural  heritage,  which  provides 
other  avenues  for  relief  of  tensions.  But  their  national  police  and  their 
customs  police  did  a  tremendous  job,  and  they  don't  have  a  heroin 
problem.  In  fact,  they  get  upset  when  there  is  a  seizure  of  marihuana, 
as  being  a  very  dangerous  thine,  and  thev  are  concerned  about  this 
Nation's  efforts  to  ease  the  penalties  in  marihuana. 

We  have  a  difficult  problem.  I  think  the  easing  of  penalties  was  good 
on  the  first  offenders. 

Chairman  Pepper.  Excuse  me.  You  say  you  have  that  report? 

Mr.  RossroES.  I  will  submit  a  statement  regarding  it. 

Chairman  Pepper.  We  will  incorporate  it  with  your  testimony. 

Mr.  RossiDES.  I  will  commend  the  Washinirton  Post  on  this,  because 
it  was  their  article  last  fall  which  was  practically  a  full  page  article. 

( The  statement  referred  to  above  follows : ) 

Japanese  Customs'  Successful  Curbing  of  Heroin  Traffic 

According  to  reports  in  the  past  few  months,  Japanese  Customs  have  success- 
fully curbed  the  importation  of  heroin  into  Japan.  Much  of  this  success  was  based 
on  tightened  surveillance  of  incoming  traffic — especially  ships. 

The  customs  officials  were  supported  in  their  effort  by  strict  enforcement  of 
narcotic  laws  by  police  who  were  well  trained  in  narcotic  enforcement,  a  hard 
hitting  press-TV  campaign,  and  the  cooperation  of  the  Japanese  people. 

Chairman  Pepper.  Any  other  questions  ? 
Mr.  Steiger.  No. 
Chairman  Pkppfj?.  Mr.  Winn  ? 
Mr.  Winn.  Thank  you,  Mr.  Chairman. 

Mr.  Secretary,  two  questions.  Do  you  consider  the  college  students 
who  bring  heroin  into  the  United  States  a  part  of  organized  crime  ? 


75 

Mr.  RossiDEs.  I  do  not  consider  it  a  part  of  organized  crime  when  a 
college  student  goes  overseas  and  purchases  some  heroin,  or  into  Mexico 
and  brings  it  back  and  sells  it  to  some  of  his  fellow  students.  The 
amount  of  this  that  goes  on,  in  my  judgment,  is  minimal,  a  very  small 
percentage.  I  don't  even  know  if  it  is  1  percent.  There  are  far  more  who 
bring  marihuana  and  hashish  into  the  country,  and  they  are  quite 
organized.  In  the  New  England  area  600  pounds  was  seized.  That 
effort  was  highly  organized  and  the  marihuana  and  hashish  were  going 
to  be  sold  to  fellow  students. 

Mr.  Winn.  My  next  question  Avas  what  percentage  and  I  think  you 
answered  that.  That  may  be  1  percent. 

Mr.  RossiDES.  Yes ;  a  very  small  amount  regarding  heroin. 

Mr.  Winn.  Do  college  students  work  with  organized  crime?  They 
may  not  be  considered  a  part  of  it,  but  they  are  working  with  the 
criminals  to  make 

Mr.  RossiDES.  Sometimes,  they  are  used  as  ducks  or  couriers.  But  do 
not  assume  anyone  who  is  bringing  in  heroin  is  an  unsophisticated, 
naive  college  student.  I  think  very  few  are  involved  in  heroin  smug- 
gling. Marihuana  and  hashish,  moreso — and  they  are  making  a  lot  of 
money  on  their  fellow  students. 

Mr.  Winn.  Thank  you. 

Chairman  Pepper.  Mr.  Keating  ? 

Mr.  Keating.  No  questions. 

Chairman  Pepper.  Any  other  questions  ? 

Mr.  Mann  ,•  No ;  thank  you. 

Chairman  Pepper.  Mi-.  Secretary,  we  thank  you  very  much  for  your 
valuable  contribution  this  morning. 

We  want  to  keep  in  touch  with  you  and  cooperate  Avith  you  in  any 
way  we  can. 
■     Mr.  RossiDES.  Thank  you,  Mr.  Chairman. 

Mr.  Perito.  Mr.  Chairman,  may  the  curriculum  vitae  of  Secretary 
Rossides  be  incorporated  in  the  record. 

Chairman  Pepper.  Without  objection,  it  is  so  ordered. 

(The  curriculum  vitae  of  Mr.  Rossides  follows:) 

[Exhibit  No.  7] 

Curriculum  Vitae  of  Eugene  T.  Rossides,  Assistant  Secretary  of  the 
Trbiasury  for  Enforcement  and  Operations 

As  Assistant  Secretary  of  the  Treasury  for  Enforcement  and  Operations,  Mr. 
Rossides'  responsibilities  include  direct  supervision  of  the  Bureau  of  Customs, 
the  U.S.  Secret  Service,  the  Bureau  of  the  Mint,  the  Bureau  of  Engraving  and 
Printing,  the  Consolidated  Federal  Law  Enforcement  Training  Center  the  Office 
of  Operations,  the  Office  of  Tariff  and  Trade  Affairs,  and  the  Office  of  Law 
Enforcement. 

Mr.  Rossides  serves  as  the  principal  law  enforcement  policy  advisor  to  the 
Secretary  of  the  Treasury.  His  responsibilities  include  providing  policy  guid- 
ance for  all  Treasury  law^  enforcement  activities,  including  those  of  the  Internal 
Revenue  Service. 

Mr.  Rossides  is  responsible  for  the  administration  of  the  antidumping  and 
countervailing  duty  laws. 

Mr^  Rossides  serves  as  U.S.  Repre.sentative  to  Interpol  (International  Crimi- 
nal Police  Organization)  and  was  elected  as  one  of  three  vice  presidents  of 
Interpol  in  October  1969. 

^  ^^,>'- I^ossides,  43,  had  been  a  partner  in  the  law  firm  of  Royalls,  Koegel,  Rogers 
&  ^\ells  (now  Royall,  Koegel  &  Wells)  of  New  York  City  and  Washington,  D.C. 


76 

From  1958  to  1961,  he  served  as  Assistant  to  Treasury  Under  Secretary  Fred  C. 
Scribner,  Jr.,  before  returning  to  the  practice  of  law  in  New  York  City. 

Early  in  his  law  career,  Mr.  Rossides  served  as  a  criminal  law  investigator  in 
the  rackets  bureau  on  the  staff  of  New  York  County  District  Attorney  Frank  S. 
Hogan. 

For  2  years,  Mr.  Rossides  was  an  assistant  attorney  general  for  the  State  of 
New  York,  having  been  appointed  by  the  then  Attorney  General  Jacob  K.  Javits, 
who  assigned  him  to  the  bureau  of  securities  to  investigate  and  prosecute  stock 
frauds. 

A  former  legal  officer  for  the  Air  Materiel  Command,  U.S.  Air  Force,  Mr.  Ros- 
sides holds  the  reserve  rank  of  Air  Force  captain. 

A  native  of  New  York,  Mr.  Rossides  graduated  from  Erasmus  Hall  High  School, 
Brooklyn,  and  received  hi'*  A.B.  decree  from  Columbia  College  in  1949.  He  re- 
ceived his  LL.B.  degree  from  Columbia  Law  School  in  1952.  He  is  a  member  of 
the  Columbia  Co  lere  Coun'^-il,  n  director  of  the  Co  umt>ia  College  Alumni  Associ- 
ation, and  a  member  of  the  Columbia  College  Varsity  "C"  football  club. 

A  member  of  the  Greek  Orthodox  Church,  he  serves  on  the  church's  highest  rul- 
ing body,  the  Archdiocesan  Council  of  the  Greek  Orthodox  Church  of  North  and 
South  America,  both  as  treasurer  and  member  of  the  coimcil's  policy  committee. 

He  is  a  vice  president  of  the  New  York  Metropolitan  Chapter  of  the  National 
Football  Foundation  and  Hall  of  Fame,  and  a  director  of  the  Touchdown  Club 
of  New  York. 

He  is  a  member  of  the  American,  Federal,  and  New  York  State  bar  associations, 
and  New  York  State  District  Attorneys  Association,  the  American  Political  Sci- 
ence Association,  and  the  Academy  of  Political  Science. 

He  is  married  to  the  former  Aphrouite  Macotsin  of  Washington,  D.C.  They 
have  three  children  Michael  Telemachus.  8;  Alexander  Demetrius,  6;  and  Eleni 
Ariadne,  3.  Mr.  Ros.sides  has  another  daughter.  Gale  Daphne,  by  a  previous 
marriage. 

Chairman  Pepper.  I  would  just  like  to  announce  before  we  break 
up  that  these  are  the  witnesses  for  tomorrow:  the  MITRE  Corp. 
representatives:  Mr.  David  Jaffe,  department  staff;  William  E. 
Holden,  department  head,  resources  planning  department;  Dr.  Walter 
F.  Yondorf ,  associate  technical  director. 

Then  next  is  Dr.  Frances  R.  Gearing,  associate  professor,  Division  of 
Epidemiology,  Columbia  University  School  of  Public  Health  and  Ad- 
ministrative Medicine. 

Next  is  Dr.  Jerome  H.  Jaffe,  director,  Illinois  Drug  Abuse  Program ; 
Wayne  Kerstetter,  University  of  Chicago  Law  School  Research  Center. 

Next  is  Dr.  Robert  L.  DuPont,  director,  Narcotics  Treatment  Ad- 
ministration for  the  District  of  Columbia. 

If  there  is  nothing  further,  we  will  recess  until  10  o'clock  tomorrow 
morning  in  this  room. 

Thank  you. 

(Whereupon,  at  1 :1T  p.m.,  the  committee  adjourned,  to  reconvene 
on  Tuesday,  April  27, 1971,  at  10  a.m.) 


NARCOTICS  RESEARCH,  REHABILITATION, 
AND  TREATMENT 


TUESDAY,   APRIL  27,    1971 

House  or  Representatives, 
Select  Committee  on  Crime, 

Washington^  D.C. 

The  committee  met,  pursuant  to  notice,  at  10 :05  a.m.,  in  room  2359, 
Rayburn  House  Office  Building,  Hon.  Claude  Pepper  (chairman) 
presiding. 

Present:  Representatives  Pepper,  Eangel,  Mann,  Brasco,  Waldie, 
Wiggins,  Steiger,  Winn,  and  Keating. 

Also  pr(;sent :  Paul  Perito,  chief  counsel ;  and  Michael  W.  Blommer, 
associate  chief  counsel. 

Chairman  Pepper.  The  committee  will  come  to  order,  please.  We  are 
very  pleased  to  see  in  the  audience  this  morning  a  large  niunber  of 
young  ladies  and  gentlemen.  We  hope  you  will  find  something  of 
interest  in  the  hearings  we  are  holding  today. 

Yesterday,  the  Crime  Committee  heard  testimony  from  three 
uniquely  qualified  and  eminently  distinguished  scientists  and  medical 
researchers.  Doctors  Seevers,  Eddy,  and  Brill  all  agreed  that  we  now 
have  sufficient  synthetic  substitutes  for  morphine  and  codeine  ca- 
pable of  satisfying  the  painkilling  and  cough  suppressing  needs  of  our 
Nation. 

For  those  who  were  not  here  yesterday,  let  me  say  that  the  Select 
Committee  on  Crime  is  trying  to  find  some  way  to  diminish  the  menace 
of  heroin  addiction  in  this  country.  We  have  already  heard  evidence  to 
show  that  in  spite  of  all  the  efforts  of  the  Federal  Government  and 
all  those  agencies  cooperating  with  the  Federal  Government,  we  seize 
only  about  20  percent  of  the  heroin  that  is  smuggled  into  this  country. 
The  other  80  percent  comes  into  this  country  to  be  the  largest  single 
cause  of  death  of  young  adults  in  some  of  our  largest  cities. 

Last  year,  in  Dade  County,  Fla.,  my  congressional  district,  we  had 
41  deaths  from  heroin.  We  have  already  had  nine  this  year.  The  num- 
ber is  in  the  several  hundreds  in  the  United  States  each  year. 

So  in  view  of  the  difficulty  of  stopping  heroin  from  coming  in,  we 
are  looking  at  some  options,  or  some  alternatives,  as  it  were.  If  we 
could  just  stop  the  worldwide  cultivation  of  the  opium  poppy  alto- 
gether, that  would,  of  course,  eliminate  that  problem.  It  would  make 
it  unnecessary  to  spend  so  much  money  trying  to  intercept  the  opium 
smuggled  into  this  country  in  the  form  of  heroin. 

But  in  order  to  do  that,  we  have  to  eliminate  a  very  large  legitimate 
need  for  derivatives  of  opium,  because  doctors  use  morphine  and  co- 

(77) 


78 

deine  in  painkilling  drugs.  So  if  we  cannot  eliminate  that  legitimate 
need  for  the  growing  of  the  opium  poppy,  it  will  continue  to  be  grown 
and  the  farmer,  at  least  according  to  the  pattern  of  the  past,  will  con- 
tinue to  divert  a  part  of  his  crop  into  the  black  market  maintained  by 
the  international  organized  crime  syndicate. 

In  order  to  eliminate  the  necessity  for  importing  certain  derivatives 
of  opium  for  medicinal  purposes,  we  are  asking  the  scientific  com- 
munity of  our  country  if  there  caimot  be  developed  synthetic  substi- 
tutes for  morphine  and  codeine  so  there  wouldn't  be  a  legitimate  need 
for  the  growing  of  the  opium  poppy  anywhere  in  the  world. 

The  other  aspect  of  this  hearing  is  to  find  blockage  drugs  which 
will  prevent  the  addict  taking  heroin  from  experiencing  any  sensa- 
tion from  it.  So  if  you  take  that  blockage  drug,  you  might  as  well  not 
take  the  heroin,  because  you  don't  derive  any  sense  of  satisfaction  from 
the  taking  of  it.  That  is  the  reason  we  are  engaged  in  this  scientific 
inquiry  into  these  areas. 

We  have  received  testimony  from  Assistant  Secretary  of  the  Treas- 
ury Eugene  T.  Rossides,  who  told  us  that  the  total  eradication  of  opium 
cultivation,  accompanied  by  domestic  reliance  upon  synthetic  sub- 
stitutes, would  be  a  definite  plus  to  the  law  enforcement  community 
charged  with  the  responsibility  of  policing  our  borders.  Mr.  Rossides 
further  told  us  that  the  switch  from  the  natural  opiates  to  the  syn- 
thetics might  well  cause  a  disruption  in  the  organized  criminal  con- 
spiracies which  are  responsible  for  bringing  most  of  the  heroin  into 
the  United  States. 

Today,  we  will  hear  testimony  from  scientific  researchers  concern- 
ing the  possibilities  of  policing  a  worldwide  opium  cultivation  ban. 
The  first  three  witnesses,  from  MITRE  Corp.,  will  tell  us  about  the 
possibility  of  using  our  satellite  capabilities  to  police  an  international 
treaty  banning  opium  cultivation.  We  will  also  hear  testmony  about 
the  role  which  the  scientific  and  engineering  community  can  play  in 
the  international  addiction  crisis. 

We  then  will  move  into  the  second  phase  of  our  hearing.  In  this 
segment  we  will  attempt  to  determine  whether  methadone  mainte- 
nance is  efficacious  in  reducing  the  number  of  arrests  and  illegal  activ- 
ities of  addicts  under  such  treatment. 

It  is  generally  said  that  it  costs  between  $50  and  $75  a  day  to  main- 
tain heroin  addiction  once  a  person  becomes  thoroughly  addicted  to 
that  drug.  Well,  not  many  people  can  afford  $50  or  $75  a  day.  Those 
who  cannot  afford  it  have  to  go  out  and  illegally  get  possession  of 
goods,  which,  when  sold  to  a  fence,  will  yield  the  amount  of  money 
they  must  have  to  sustain  their  addiction. 

It  is  estimated  bv  Dr.  DuPont,  who  is  in  charge  of  the  Narcotics 
Treatment  Administration  here  in  the  District  of  Columbia,  that 
each  addict  in  the  District  of  Columbia  gets  illegal  possession  of  about 
$50,000  worth  of  goods  a  year  in  order  to  sustain  his  addiction.  With 
some  16,000  addicts  in  the  District,  it  is  no  wonder  we  have  so  many 
robbery,  burglaries,  and  muggings  on  the  street. 

Our  next  witness.  Dr.  Frances  R.  Gearing,  is  eminently  qualified  to 
give  us  an  analytical  and  statistical  survey  of  Dr.  Vincent  Dole's  meth- 
adone maintenance  program  that  will  help  us  in  determining  the  ef- 
ficacv  of  the  methadone  maintenance  approach. 


79 

We  then  will  hear  from  Dr.  Robert  L.  DuPont,  Director  of  the  Nar- 
cotics Treatment  Administi-ation,  who  has  compiled  some  fascinating 
statistical  studies  on  crime  reduction  and  methadone  maintenance  in 
Washington, 

Our  final  witness  today  is  Dr.  Jerome  H.  Jaffe,  director  of  the  Illi- 
nois Drug  Abuse  Program.  This  multimodality  treatment  program  is 
the  largest  in  the  Midwest.  Currently  Dr.  Jaffe  and  his  able  staff  are 
treating  1,590  addicts.  Dr.  Jaffe  will  explain  his  approach  to  metha- 
done maintenance  and  the  multimodality  treatment  method.  He  will 
also  share  with  us  his  thinking  about  the  possibilities  of  developing 
longer  lasting  and  effective  antagonist  drugs.  Finally,  Dr.  Jaffe  will 
advise  us  how  we  can  best  accelerate  and  coordinate  scientific  research 
into  the  multiple  problems  of  opiate  addiction. 

Our  first  witnesses  this  morning  are  three  gentlemen  who  represent 
what  America's  advanced  technology  can  contribute  to  the  fight  against 
social  ills.  David  Jaffe,  William  E.  Holden,  and  Dr.  Walter  F.  Yon- 
dorf  are  employees  of  the  MITRE  Corp.,  a  research  and  development 
think-tank  with  heavy  experience  in  space  and  defense. 

These  gentlemen  are  now  applying  their  technology  to  the  possibil- 
ity of  detecting  the  illegal  cultivation  of  opium. 

Mr.  Jaffe  is  a  memlier  of  the  department  staff  of  MITRE,  and  is 
primarily  concerned  with  the  application  of  technology  to  criminal 
justice  systems. 

Before  joining  MITRE  last  September,  he  was  deputy  head  of  the 
public  safety  department  of  the  Research  Analysis  Corlp.,  where  he  de- 
veloped program  concepts  for  research  in  law  enforcement  and  the 
administration  of  justice.  Studies  he  directed  included  the  relationship 
between  the  physical  environment  and  the  crime  rate,  logistic  support 
to  police  and  fire  departments  in  combating  civil  disorders,  and  the  role 
of  police  in  a  ghetto  community. 

Mr.  Jaffe  holds  a  master  of  science  degree  in  physics  and  mathemat- 
ics from  the  University  of  Connecticut. 

Mr.  Holden,  a  MITRE  department  head,  is  an  electrical  engineer 
with  a  bachelor  of  science  degree  from  the  Massachusetts  Institute  of 
Technology,  and  a  former  naval  aviator.  During  the  last  15  years  at 
Lincoln  Laiboratory,  MIT,  and  with  MITRE,  Mr.  Holden  has  been 
responsible  for  many  mission  analyses  and  other  planning  activities 
in  the  fields  of  air  defense,  command  and  control  at  senior  military 
levels,  foreign  satellite  identification,  airborne  command  posts,  air- 
borne launch  facilities,  missile  test  ranges,  and  Air  Force  test  centers. 
He  served  as  a  foreign  service  officer  assigned  to  the  NATO  interna- 
tional staff  for  2  years  to  assist  in  planning  NATO-wide  air  defenses. 

Dr.  Yondorf  is  associate  technical  director  of  MITRE  Corp's  na- 
tional command  and  control  division  in  McLean,  Va.  The  division 
provides  systems  engineering  and  other  scientific  and  technical  assist- 
ance to  defense  agencies,  primarily  in  the  areas  of  communications, 
data  processing,  and  sensor  development.  Sponsors  include  the  De- 
fense Communications  Agency,  the  Defense  Special  Projects  Group, 
Safeguard  Systems  Command,  Air  Force  Systems  Command  and  the 
Advance  Research  Project  Agency.  Dr.  Yondorf's  earlier  MITRE  as- 
signments have  included  the  development  and  implementation  of  a 
5-year  project  to  improve  and  automate  JCS  strategic  mobility  plan- 


80 

ning  capabilities,  responsibility  for  requirements  analysis  of  the  Na- 
tional Military  Command  System,  the  study  of  attack  assessment  sys- 
tems, and  research  in  crisis  management. 

Before  joining  MITRE  in  1962,  Dr.  Yondorf  was  a  senior  staff  mem- 
ber at  the  Laboratories  for  Applied  Sciences,  University  of  Chicago, 
where  he  was  engaged  in  strategic  studies  and  the  political  and  eco- 
nomic analysis  of  limited  conflict.  Earlier,  he  was  an  instructor  at 
the  University  of  Chicago  teaching  courses  in  the  committee  on  com- 
munication. 

As  a  fellow  of  the  Social  Science  Research  Council,  1959-60,  Dr. 
Yondorf  undertook  a  study  of  the  dynamics  of  political  and  economic 
integration  in  the  European  Common  Market. 

Dr.  Yondorf  was  educated  in  Germany,  Switzerland,  and  the  United 
States,  and  holds  M.A.  and  Ph.  D.  degrees  in  political  science  from  the 
University  of  Chicago. 

Gentlemen,  we  are  pleased  to  have  you  with  us  today. 

Mr.  Perito,  our  chief  counsel,  will  you  please  inquire  of  the  witness. 

Mr.  Perito.  Mr.  Jaffe,  I  understand  that  you  have  a  prepared 
statement  ? 

STATEMENT  OF  DAVID  JAFFE,  DEPARTMENT  STAFF,  MITRE  CORP. ; 
ACCOMPANIED  BY :  WILLIAM  HOLDEN,  DEPARTMENT  HEAD;  AND 
DR.  WALTER  YONDORF,  ASSOCIATE  TECHNICAL  DIRECTOR, 
NATIONAL  COMMAND  AND  CONTROL  DIVISION 

Mr.  Jaffe.  Yes ;  I  do. 

Mr.  Perito.  Would  you  care  to  read  that  statement  for  the 
committee  ? 

Mr.  Jaffe.  Yes. 

Mr.  Perito.  Thank  you,  please  proceed. 

Mr.  Jaffe.  Thank  you  very  much.  I  am  pleased  to  contribute  to 
the  work  of  this  committee  at  your  kind  invitation,  and  am  grateful 
for  the  opportunity  to  discuss  with  you  the  role  that  the  technical 
community  should  be  playing  in  the  control  of  narcotic  and  dangerous 
drugs.  I  will  suggest  how  the  application  of  technology  could  make 
some  significant  contribution  to  the  solution  of  the  pressing  and  criti- 
cal problems  of  drug  abuse  and  to  the  control  thereof :  I  will  describe 
some  typical  benefits  that  may  be  derived  from  the  adaptation  of  ad- 
vanced techniques;  and  I  will  suggest  a  program  for  realizing  such 
benefits. 

A  little  less  than  a  year  ago  this  committee  heard  a  presentation  by 
Dr.  William  F.  Ulrich  of  Beckman  Instruments  in  which  he  outlined 
the  ways  in  which  scientific  and  engineering  capabilities  could  con- 
tribute to  drug  control.  He  touched  on  the  subjects  of  technology 
transfer  and  systems  analysis,  and  I  would  like  to  expand  on  those 
topics  to  show  how  some  specific  programs  might  assist  those  conduct- 
ing the  fight  against  illicit  drug  production  and  distribution. 

Suggestions  on  how  to  solve  the  drug  problem  differ  as  to  approach. 
There  are  those  who  argue  for  an  attack  on  the  sources:  Foreign 
growers  of  opium  and  local  manufacturers  of  psychotropic  substances. 


$1 

There  are  others  who  would  have  us  concentrate  on  interrupting  the 
distribution  channels.  Still  others  believe  the  attack  should  be  focused 
on  rehabilitating  the  users.  I  submit  that  we  need  a  coordinated  effort 
in  all  these  directions. 

To  say  that  the  problem  is  complex  is  not  to  argue  that  solutions  are 
impossible,  or  slow  to  be  realized.  My  thesis  is  rather  that,  if  we  are 
to  achieve  effective  controls  in  reasonable  time,  we  must  begin  by 
accepting  the  complexity,  understanding  it  fully,  and  devising  rea- 
soned rather  than  intuitive  or  emotional  responses. 

Techniques  which  were  developed  for  analysis  of  highly  complex 
systems,  if  properly  understood  and  managed,  can  be  powerful  weap- 
ons in  revealing  subtle  relationships  and  vulnerabilities.  The  methods 
of  systems  analysis  and  systems  engineering  are  not  cure-alls.  As 
with  any  highly  structured  method,  the  results  cannot  be  more  precise 
than  the  information  used. 

BACKGROUND 

What  then  are  the  particular  problems  which  should  be  addressed 
by  the  scientific  and  engineering  community  ? 

Source  Detection 

The  sources  of  opium,  the  fields  of  the  Middle  East,  Southern  Asia, 
and  of  Southeast  Asia,  present  an  interesting  challenge  because  of  the 
combination  of  difficulties  encountered.  To  begin  with  there  is  the 
problem  of  detecting  the  presence  of  small,  out-of-the-way,  illicit 
crops,  primarily  an  operational  and  technological  problem.  Then  there 
is  the  consideration  that  opium  is  often  the  principal  or  only  cash 
crop  for  the  local  farmer,  an  economic  problem.  In  Southeast  Asia, 
some  tribes  have  built  a  nomadic  lifestyle  based  on  opium  poppy  culti- 
vation, a  sociological  problem.  And  we  hear  frequently  about  the  polit- 
ical barriers  to  opium  control. 

The  necessity  to  solve  each  kind  of  problem,  and  all  of  them  on  an 
integrated  basis,  is  apparent.  The  detection  of  illicit  crops  is  a  key 
factor  in  the  entire  process  because  it  should  provide  the  detailed 
facts  on  which  can  be  based  the  economic,  social,  and  political  solu- 
tions. Other  parts  of  an  integrated  program  rely,  to  some  degree,  on 
being  able  to  specify  the  location  and  extent  of  illicit  opium  cultiva- 
tion with  precision  and  confidence. 

Laboratory  Detection 

A  second  major  problem  area  which  may  be  amenable  to  techno- 
logical attack  is  the  location  of  the  laboratories  where  the  opium  and 
morphine  bases  are  transformed  into  heroin. 

In  the  past,  these  laboratories  have  escaped  detection  from  the  air. 
They  remain  prime  targets  partly  because  of  their  strategic  function 
in  the  heroin  supply  process,  and  partly  because  much  raw  material 
and  important  personnel  can  be  captured  at  these  places. 

Tracers 

It  would  be  helpful  to  law  enforcement  officers  if  they  could  reliably 
trace  the  movement  and  chemical  transformation  of  narcotic  ma- 


82 

terials.  If  they  could  introduce  an  identifiable  tag  at  the  poppyfield 
and  intercept  some  of  that  material  at  several  points  in  the  distribu- 
tion network,  a  much  clearer  description  of  that  network  would  result. 
The  operational  possibilities  for  such  tracer  materials  are  numerous. 
The  problem  is  in  finding  suitable  tags  which  are,  among  other  things, 
reliable  and  safe. 

Sensors 

Another  problem  susceptible  to  technological  solution  is  the  detec- 
tion of  concealed  drugs  at  short  distances.  It  would  be  of  immeasur- 
able value  to  be  able  to  reveal  the  presence  of  drugs  hidden  in  suit- 
cases, automobiles,  packages,  on  the  person,  and  in  many  other  places. 
Devices  are  needed  which  can  detect  extremely  small  amounts  of  opi- 
ates w^ith  response  times  of  seconds  and  reliability  in  the  upper  90 
percentile.  The  requirements  of  sensitivity,  speed,  and  reliability  tend 
to  be  mutually  exclusive  and  difficult  to  achieve.  Development  of  such 
devices  requires  extensive  research  and  design  and  some  amount  of 
tradeoffs  in  design. 

Data  Bank 

The  complexity  of  the  international  drug  enterprise  is  reflected  in 
the  great  amount  of  information  needed  to  describe  the  production, 
distribution,  and  consumption  of  the  products.  The  effectiveness  of 
drug  control  is  dependent  on  access  to  that  information.  And  the  ef- 
fectiveness will  also  be  a  function  of  how  timely  the  retrieval  is  and  of 
how  complete  is  the  data  produced. 

It  follows  that  a  comprehensive  data  bank  is  required  as  a  reposi- 
tory of  worldwide  information  on  all  aspects  of  the  drug  problem. 
Narcotics  agents  at  all  levels  should  be  able  to  request  rapid  retrieval 
of  information.  The  high  mobility  of  dealers  in  drugs  and  the  world- 
wide nature  of  their  operations  suggest  the  need  for  a  similarly  ex- 
tensive data  bank. 

O'perations  Analysis 

Referring  again  to  the  intricate  nature  of  the  illicit  drug  business, 
it  is  often  difficult  to  predict  the  ultimate  consequences  of  any  control 
activity.  Squeezing  the  balloon  at  one  place  may  simply  cause  it  to 
expand  some  place  else.  A  comprehensive,  systematic,  analytic  method 
is  needed  which  can  help  to  identify  how  other  parts  of  the  system 
will  be  affected  if  one  part  is  changed. 

A  corollary  problem  is  the  allocation  of  drug  control  resources. 
Like  managers  in  all  other  situations,  drug  control  administrators 
must  decide  how  to  assign  their  personnel,  equipment,  dollars,  and 
management  attention  so  as  to  realize  the  most  beneficial  results.  It 
would  help  these  people  to  have  a  technique  for  anticipating  the 
effects  of  their  allocation  decisions.  No  such  technique  will  replace  a 
good  manager,  but  it  can  provide  him  with  information  he  would 
otherwise  not  have. 

BENEFITS 

Some  of  the  benefits  which  should  be  derived  from  such  efforts 
by  the  scientific  and  engineering  community  are : 
Worldwide  location  of  opium  crops ; 
Information  on  potential  yield  of  opium  crops ; 


83 

Determination  of  harvesting  time ; 

Selective  destruction  of  crops ; 

Tracing  of  distribution  networks ; 

Sensing  of  concealed  material  at  ports  of  entry ; 

Detection  of  clandestine  laboratories ; 

Kapid  retrieval  of  pertinent  data ; 

Identification  of  network  sensitivities  and  vulnerabilities ; 

Assessment  of  alternative  control  measures  : 

Mechanism  for  training  exercises ;  and 

Good  resource  management. 

I  must  urge  you  to  keep  in  mind  that  these  benefits,  as  I  have  been 
calling  them,  are  not  going  to  solve  the  full  range  of  narcotic  and 
drug  problems.  In  fact,  we  cannot  be  entirely  certain  that  all  of  these 
benefits,  and  others  which  could  be  added  to  the  list,  can  be  achieved 
in  a  reasonable  time  or  at  acceptable  costs.  And  the  changing  opera- 
tional requirements  may  make  some  of  them  obsolete  before  long. 

But  for  the  present,  we  should  not  overlook  any  tool  which  answers 
a  real  need,  and  these  benefits  can  be  vital  elements  to  the  integrated, 
coordinated  attack  which,  in  my  opinion,  is  the  only  reasonable  route 
to  effective  control. 

PROPOSED   PROGRAM 

Before  identifying  how  the  scientific  and  engineering  community 
might  participate  in  the  control  of  drugs,  I  wish  to  acknowledge  that 
there  are  already  in  progress  some  efforts  along  the  lines  to  be  de- 
scribed. The  Bureau  of  Narcotics  and  Dangerous  Drugs  and  the  Bu- 
reau of  Customs  have  active  research  and  development  programs  which 
address  many  of  the  points  contained  in  this  statement.  In  addition 
to  their  own  projects,  these  Bureaus  are  being  assisted  by  other  Fed- 
eral agencies  which  have  specialized  capabilities.  I  have  met  with  a 
number  of  people  involved  in  these  efforts  and  can  attest  to  their 
competence  and  dedication.  But  the  scope  of  the  ongoing  efforts,  and 
the  adequacy  of  available  resources,  remain  as  appropriate  questions 
before  this  committee.  I  will  return  to  this  issue  presently. 

Having  established  some  of  the  benefits  which  research  and  develop- 
ment should  pi'oduce,  let  us  examine  how  such  a  program  might  be 
structured.  We  can  conveniently  view  the  woi'k  that  needs  to  be  done 
as  a  five-part  program. 

Surveillance  of  Opiy/m  Poppy  Crops 

The  remote  sensing — that  is,  from  aircraft  and  satellites — of  agri- 
cultural crops  dates  from  the  early  1930's  when  aerial  photographs 
were  used  to  locate  and  measure  fields.  Since  then,  observational  and 
interpretive  techniques  have  progressed  a  great  deal,  although  much 
experimentation  and  development  remains  to  be  accomplished.  I  have 
several  photographs  to  illustrate  what  can  be  accomplished  with  ad- 
vanced techniques. 

Mr.  Perito.  Mr.  Chairman,  may  the  record  reflect  the  lights  are  noAv 
being  turned  out  and  the  photographs  about  to  be  shown  will  be  made 
available  for  the  committee  to  incorporate  in  its  record. 

Chairman  Pepper.  So  ordered. 

Mr.  Jafte.  The  first  figure  is  a  well-known  photo  made  from  Apollo 
9  at  131  nautical  miles  over  Imperial  Valley,  Calif.  It  was  taken  with 


84 


Figure  1 


infrared  Ektachrome  film  with  a  spectral  response  between  0.510  and 
0.890  microns.  The  dark  dotted  patches  are  crops.  Across  the  bottom  is 
seen  a  section  in  which  the  amount  of  dotted  area,  and  consequently  the 
vigor  of  the  vegetation,  is  markedly  lower.  That  sharp  line  of  demarka- 
tion  is  close  to  the  Mexican  border.  A  single  color  photograph  like  this 
one  contains  limited  useful  information. 

The  next  figure  (fig.  2)  shows  the  same  scene  in  three  photos  made  at 
the  same  time.  The  one  on  the  upi^er  left  was  taken  with  Pan  X  film 
with  a  green  filter;  the  upjx^r  right  on  Pan  X  with  a  red  filter;  and  the 
lower  photo  on  black  and  white  film  "sensitive  to  infrared  radiation.  It 
is  apparent  that  each  photo  produces  different  relative  contrasts  and 
enhances  the  images  of  some  features  over  others. 

The  next  photos  (fig.  3)  demonstrate  the  different  resi^nses  that 
similar  crops  will  provide  in  relatively  narrow  spectral  bands.  The  left 
photo,  made  with  a  blue  filter,  shows  little  difference  between  oats  and 


85 


Figure  2 


wheat.  But  the  ones  made  with  red  and  infrared  filters  show  the  dis- 
tinction quite  clearly.  So,  in  a  simple  case  at  least,  we  see  that  it  is 
ix)ssible  to  isolate  crops  in  this  way. 

In  fact,  it  is  possible  to  do  a  lot  better  than  that.  The  next  photos 
(fig.  4)  show  how  two  varieties  of  corn  which  can  hardly  be  differenti- 
ated at  visible  wavelengths  (on  the  left)  look  quite  different  at  infrared 
wavelengths. 

Mr.  Perito.  May  the  record  reflect  the  lights  being  turned  back  on 
and  we  are  continuing  with  Mr.  Jaffe's  statement. 

Chairman  Peppek.  Without  objection,  so  ordered. 

You  may  proceed. 

Mr.  Jaffe.  What  I  have  illustrated  here  are  the  mere  fundamentals 
of  remote  sensing  of  agriculture.  These  techniques  have  been  advanced 


86 


Figure  3. — Tones  of  wheat  (W)  and  oats  (O)  differ  when  recorded  by  an  airborne 
multilens  camera  filtered  to  three  spectral  regions  (0.38  to  0.44  micron,  at  left ; 
0.62  to  0.68,  center;  and  0.58    to  0.89,  at  right). 

[Data  Collected  by  Purdue  University  Agronomy  Farm.] 

to  include  simultaneous  observation  in  many  spectral  bands  and  com- 
puter analysis  of  the  data. 

I  am  not  aware  of  opium  poppies  having  been  observed  by  these 
methods,  but  it  is  reasonable  to  expect  that  they  would  be  readily  dis- 
cernible; perhaps  even  by  single  band,  rather  than  multispectral,  sens- 
ing. "VVliat  is  needed  is  a  set  of  experiments  to  establish  which  ap- 
proach produces  the  desired  information  with  reference  to  opium 
poppy  cultivation.  It  should  be  possible  to  use  either  an  established 
poppyfield  or  a  specially  prepared  one  and  to  overfly  it  with  equip- 
ment designed  for  spectral  analysis.  The  signatures  of  poppies  could 
thus  be  obtained  and  examined  for  uniqueness.  Once  unique,  charac- 
teristic images  are  obtained  from  the  test  bed,  the  appropriate  appa- 
ratus would  be  used  in  an  operational  test  to  determine  what,  if  any, 
real-life  difficulties  might  be  encountered.  Further  refinement  of  the 
technique  would  follow. 

Remote  sensing  from  aircraft  is  very  likely  to  be  successful  in  locat- 
ing opium  fields.  Similar  observations  from  satellites,  particularly 
from  NASA's  Earth  Resources  Technology  Satellite  (ERTS),  are 
somewhat  less  certain  to  produce  useful  results.  The  multispectral 
sensing  devices  on  the  initial  ERTS  spacecraft  will  provide  resolution 
of  objects  down  to  about  300  or  400  feet.  The  smallest  opium  fields 
are  said  to  be  about  i/^  acre  or  typically  about  150  feet  in  linear  di- 
mension. It  is  possible,  but  not  at  all  certain,  that  a  distinctive  signa- 
ture of  that  size  will  be  discernible  by  an  instrument  with  the  resolu- 
tion available  on  ERTS.  Needed  is  experimental  determination  of  the 
poppy  signatures  and  some  experience  with  the  real  capabilities  of  the 
ERTS  instruments.  We  must  also  consider  future  instruments  that 
may  provide  finer  resolution  and  other  favorable  characteristics. 

Trace?'  Technology 

Tracers,  or  tag  identifiers,  can  be  used  to  identify  captured  samples 
as  coming  from  the  same  sources.  It  may  be  possible  to  introduce  trac- 


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ers  at  the  poppyfields  or  at  any  point  thereafter.  For  manufactured 
drugs,  methods  of  tracing  are  not  nearly  as  difficult  because  of  distinc- 
tive characteristics  of  tablets  and  capsules. 

Four  primary  handicaps  exist  in  the  use  of  trace  materials ;  insert- 
ing the  tracers  into  the  drugs  and  the  tagged  drugs  into  the  illicit 
traffic ;  the  tracer  must  be  safe  for  use  internally  or  intravenously ;  the 
tracer  must  be  highly  reliable ;  and  a  tracer,  to  remain  a  unique  identi- 
fier, cannot  be  reused  until  the  tagged  material  has  been  cleared  from 
the  marketplace — a  condition  which  can  require  several  years. 

The  advantages  to  be  derived  from  being  able  to  correlate  the  origin 
of  captured  samples,  and  therefore  being  able  to  correlate  the  network 
links  and  nodes,  should  compensate  for  the  difficulties  involved  in  over- 
coming the  handicaps.  Captured  shipments  can  be  tagged  and  rein- 
serted in  the  network ;  radioactive  tracers  may  not  be  totally  safe,  but 
chemically  idenifiable  tag  materials  are  possible;  the  reliability  of 
unique  identification  can  be  very  high;  and  large  numbers  of  trace 
materials  can  be  found  in  time.  To  introduce  tracer  materials  into  the 
poppy  plant,  and  consequently  into  the  opium,  requires  trace  materials 
that  can  survive  the  processing  that  transform  the  opium  into  heroin. 
Analysis  of  the  morphine  alkaloid,  the  heroin,  and  the  impurities  that 
remain  after  processing  could  suggest  ways  of  altering  the  chemical 
composition.  Alterations  would  presumably  be  distinguishable  and 
hence  would  serve  to  identify  a  particular  batch  of  material. 

Trace  materials  can  also  be  inserted  into  the  distribution  network 
at  points  other  than  the  source.  For  this  purpose,  it  is  necessary  to 
have  tag  materials  which  replace  those  used  at  later  stages  in  the  proc- 
ess. For  example,  it  could  be  possible  to  use  traceable  acetic  anhydride 
in  converting  morphine  base  into  heroin  (diacetylmorphine). 

It  should  also  be  feasible  to  introduce  trace  materials  still  later  in 
the  network ;  as  for  example,  during  the  cutting  phases.  Either  chem- 
ically distinguishable  but  similar  substances  could  be  used,  or  inert 
and  distinctive  things,  perhaps  plastics,  could  be  added.  But  all  of  this 
will  take  intensive  investigation  and  development  before  operational 
utility  is  achieved. 

Sensor  Technology 

Sensors  for  the  detection  of  concealed  narcotics  and  drugs,  and  for 
the  detection  of  effluents  at  heroin  laboratories,  will  also  require  dedi- 
cated research  and  development.  The  first  task  will  be  to  identify 
technioues  which  can  sense  very  small  amounts  of  drugs  or  related 
materials.  The  second  task  will  be  the  adaptation  of  those  techniqu'°s 
to  operationally  useful  forms. 

More  so  than  for  other  technological  weapons,  sensors  are  highly 
susceptable  to  countermeasures.  It  should  be  fairly  easy,  once  the  sens- 
ing technique  is  recognized,  for  the  narcotic  distributors  to  devise  eva- 
sive procedures  or  devices.  The  need  is  therefore  for  an  arsenal  of  sen- 
sors and  a  variety  of  ways  for  utilizing  them  in  order  to  keep  the  other 
side  off  balance. 

There  are  a  number  of  analytic  technioues  which  are  useful  in 
identifying  narcotic  and  dangerous  drugs.  These  methods  include  gas 
chromatography,  infrared  spectroscopy,  mass  spectroscopy.  X-ray 
spectroscopy,  free  radical  electron  resonance,  and  a  number  of  chemi- 
cal analyses.  But  the  apparatus  which  is  most  attractive  for  the  opera- 


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tional  situations  has  handicaps.  These  devices  require  preconcentration 
of  the  sample  material,  are  too  heavy  to  be  portable,  or  may  react  too 
slowly  for  expedient  analysis. 

However,  mass  spectrometers  have  been  made  with  reduced  size  and 
weight,  and  trade-offs  are  possible  in  design  requirements.  The  recent 
intensive  effort  in  developing  air  pollution  monitoring  equipment  has 
resulted  in  promising  devices  and  technology  which  might  be  applied 
to  the  near  real-time  detection  of  gas  or  particulate  contaminants  as- 
sociated with  the  production  of  controlled  drugs.  ^lerging  the  fields 
of  qualitative  instrumental  analysis  with  particulate  detection,  the 
possibility  arises  of  highly  special  and  sensitive  mechanical  sensors. 
Dr.  Lou  Rabben  of  the  MITRE  Corp.  suggested  a  scheme  developed 
for  another  purpose.  He  proposes  to  use  an  infrared  spectrometer  with 
a  sample  chamber  constructed  in  such  a  manner  that  the  infrared  beam 
passes  through  the  gas  sample  many  more  times  than  is  usually  the 
case  for  this  type  of  analysis.  Hopefully,  this  would  result  in  greatly 
enhanced  sensitivity.  I  must  emphasize  that  the  applicability  of  this 
or  other  techniques  to  drug  detection  is  unknown.  I  merely  wish  to 
suggest  examples  of  how  the  application  of  sensor  technology  might 
be  pursued  in  the  solution  of  these  problems.  Similar  developments 
may  be  possible  with  other  techniques.  Adaptation  of  existing  tech- 
nology would  seem  to  be  a  sensible  approach  to  the  initial  acquisition 
of  suitable  equipment. 

Data  handling 

I  spoke  isarlier  of  the  need  for  a  comprehensive  data  bank  covering 
all  facets  of  the  drug  enterprise.  A  data  bank  will  serve  both  the  re- 
search community  in  its  efforts  to  analyze  the  system  and  find  its  weak- 
nesses, and  the  enforcement  agencies  in  their  operational  activities.  I 
doubt  the  need  to  elaborate  on  this  item  except  to  mention  that  a  modest 
start  has  been  made  in  this  direction. 

Network  modeling 

The  established  technique  of  network  modeling  could  be  applied  to 
describe  the  entire  procedure  whereby  narcotic  and  dangerous  drugs 
proceed  from  source  to  user.  Such  a  model  would  include : 

(1)  Location  of  illicit  poppy  fields;  (2)  growing  seasons  of  illicit 
poppyfields;  (3)  economic  analysis  of  poppy  cultivation ;  (4)  packag- 
ing and  transport  of  raw  opium;   (5)  ports  of  exit  and  entry,  plus 
procedures  followed  to  avoid  detection;  (6)  chemical  processing: 
(a)  plant  locations, 
( h )  methods  of  shipment  to  and  from, 

(c)  possible  signatures  of  processing  effluents,  and 

[d)  chemical  and  supplies  used ;  where  obtained ; 

(7)  finished  product  handling  and  shipping;  (8)  distribution 
systems : 

{a)  economic  analysis, 

(6)   organizational  structure;  and 

(9)  covert  intelligence ;  its  cost  versus  its  value. 

At  each  point  of  the  network,  alternative  routings,  sources  or  pro- 
cedures should  be  identified  to  reveal  how  the  network  Avould  be  dis- 
rupted by  elimination  or  modification  of  that  point. 

The  economic  as  well  as  physical  networks  should  be  simulated  and 
these  models  should  be  operated  to  determine  alternative  control  meas- 


91 

ures;  to  assess  likelihoods  of  success  of  those  control  measures;  to 
evaluate  sensitivities  of  the  systems  to  variations  of  the  elements;  and 
to  identify  the  links  and  modes  which  may  be  most  susceptible  to  at- 
tack. A  corollary  use  of  the  models  should  be  the  training  of  super- 
visory level  personnel  in  the  Federal  and  local  enforcement  agencies. 

APPROACH 

A  few  words  on  how  to  proceed  with  a  research  and  development 
program. 

The  various  aspects  of  applicable  technology- — surveillance,  trac- 
ers, sensors,  a  data  bank,  and  network  modeling — must  be  structured 
into  an  integrated  and  focused  research  and  development  program. 
In  a  systems  approach  of  this  kind,  the  benefits  are  not  only  those  re- 
sulting from  each  specialized  technique  or  procedure,  but  also  from 
the  coordinated  use  of  all  methods  available. 

As  mentioned  earlier,  there  is  some  work  underway  in  the  areas 
cited,  so  any  program  should  begin  by  assessing  the  scope  and  direc- 
tion of  those  efforts,  I  have  made  a  limited  survey  which  indicated  that 
current  efforts  are  minimal. 

In  addition  to  a  status  survey,  an  intensive  feasibility  analysis 
should  be  undertaken  to  reveal  what  may  be  technologically,  eco- 
nomically, and  operationally  possible  both  in  the  short  term  and  the 
far  term.  This  feasibility  study  would,  using  a  complete  systems  ap- 
proach, show  just  which  of  the  areas  I  have  mentioned  are  most  fruit- 
ful to  pursue  at  the  present  time.  The  efforts  in  this  area  which  are 
underway  at  BNDI)  and  the  Bureau  of  Customs,  and  through  them  by 
other  agencies,  need  to  be  enlarged  and  unified  by  this  coordinated 
across-the-board  attack  on  the  drug  problem.  Important  consideration 
should  be  the  operational  needs — the  real-life  situations  faced  by  en- 
forcement agents — and  potential  countermeasures. 

The  feasibility  analysis  should  be  followed  by  a  detailed  research 
and  development  plan  providing  for  the  elements  of  the  program  sug- 
gested above  and  including  cost  estimates  and  multiyear  projections. 
The  plan  must  be  produced  from  the  point  of  view  of  an  attack  on  the 
entire  drug  problem ;  from  the  producers  to  the  chemical  processors 
to  the  street  level  distributors  and  users.  The  drug  problem  is  not 
static;  the  planning  and  implementation  of  its  control  cannot  be  static 
either.  Every  plan  must  be  part  of  a  logical  long-term  effort,  but  the 
plan  will  change  as  the  problem  changes.  The  plan  should  include 
provision  for  evaluation  of  results  achieved  and  for  readjustments  in 
scope  and  direction. 

SUMMARY 

I  have  tried  to  indicate  some  of  the  problems  faced  by  drug  con- 
trol agencies,  to  show  what  benefits  could  be  derived  from  increased 
employment  of  technology,  and  to  indicate  an  approach  to  increased 
involvement  by  the  research  and  development  community. 

Programs  of  the  kind  suggested  are  not  inexpensive  and  often  re- 
quire more  time  than  one  would  like.  But  in  the  context  of  the  overall 
drug  problem  and  its  direct  and  indirect  social  and  economic  drain 
on  our  society,  the  costs  of  an  intense  research  and  development  pro- 
gram would  be  small  indeed  in  view  of  the  potential  benefits,  such 
as — 


92 

Locating  illicit  opium  crops ; 
Detecting  illegal  material  at  ports  of  entry ; 
Developing  drug  network  vulnerability  data ;  and 
Improving  resource  management. 

The  important  aspects  are  (1)  the  need  for  a  total  systems  ap- 
proach; (2)  the  need  for  an  accelerated  research  and  development 
effort ;  and  (3)  the  need  to  get  started  now. 

Thank  you  very  much. 

Chairman  Pepper.  Mr.  Jaffe,  I  want  to  commend  you  on  your  mag- 
nificent and  comprehensive  statement,  that  you  have  given  as  to  how 
this  whole  problem  should  be  coordinated  in  an  effective  and  compre- 
hensive program. 

Mr.  Perito,  do  you  have  any  questions  ? 

Mr.  Perito.  Mr.  Jaffe,  you  have  had  some  contact  both  with  the 
Federal  Bureau  of  Narcotics  and  Dangerous  Drugs,  and  U.S.  Customs 
regarding  your  presentation ;  is  that  correct  ? 

Mr.  Jafft:.  Yes. 

Mr.  Pertto.  Could  you  estimate  what  it  would  cost  the  Government 
at  this  point  to  put  together  the  type  of  research  and  development 
program  which  you  have  suggested  ? 

Mr.  Jaffe.  It  is  very  difficult  to  answer  that  on  a  short-term  basis. 
On  a  longer  term  basis,  and  comparing  it  to  the  existing  budgets  as 
I  have  been  able  to  reconstruct  them,  which  is  difficult,  I  would  guess 
it  runs  something  on  the  order  of  $10  million  over  a  5-year  period; 
something  like  that. 

Chairman  Pepper.  Excuse  me. 

You  mean  $10  million  for  5  years  ? 

Mr.  Jaffe.  Distributed  over  a  5-year  period. 

Mr.  Perito.  Mr.  Jaffe,  do  you  know  how  much  is  now  being  spent  on 
such  efforts  by  the  Federal  Government  ? 

Mr.  Jaffe.  No  ;  I  do  not  know  precisely.  I  have  some  bits  and  pieces 
of  information  about  what  particular  subagencies  are  spending,  but 
that  is  all. 

Mr.  Perito.  I  assume  then,  based  upon  your  contacts,  vou  would 
conclude  that  the  Federal  Government  is  spending  something  mini- 
mal, at  best  ? 

Mr.  Jaffe.  Oh.  very  minimal. 

Mr.  Perito.  If  you  were  assigned  the  responsibility  of  policing  an 
international  narcotics  treaty,  wherein  all  the  signatories  would  agree 
not  to  Arrow  poppies,  do  vou  believe  this  technological  approach  could 
be  used  by  the  International  Narcotics  Control  Board,  for  example, 
to  police  throuflfh  satellite  surveillance  the  cultivation  of  poppies? 

Mr.  Jaffe.  The  use  of  satellite  surveillance  may  not  be  available  to 
us  in  the  immediate  future.  But  high-flying  aircraft,  and  ultimately 
the  use  of  satellites,  will  provide  that  kind  of  capability.  It  would  sig- 
nificantlv  contribute — in  fact,  it  is  difficult  to  imagine  how  such  a 
treaty  would  be  enforceable  without  such  surveillance  or  something 
equivalent. 

Mr.  Perito.  At  the  present  time,  do  you  know  of  any  accelerated  re- 
search concerning  an  international  data  bank? 

Mr.  Jaffe.  I  don't  have  anv  specific  knowledge  about  that;  no. 

Mr.  Perito.  Do  you  envision  that  a  data  bank  could  be  set  up  so 
that  you  could  have  input  from  several  countries  and  protect  the  dis- 
closure from  those  people  who  should  not  get  disclosure  ? 


93 

In  other  words,  can  you  envision  a  data  bank  which  would  suffi- 
ciently service  an  organization  like  Interpol,  yet  at  the  same  time  not 
be  available  to  the  individuals  who  could  wrongfully  profit  by  this 
information  ? 

Mr.  Jaffe.  The  question  of  security  in  data  banks  has  received  a  lot 
of  attention  of  late,  and  I  would  suspect  that  the  probability  is  it  could 
be  done  as  well  as  it  coud  be  done  in  any  other  area.  I  think  that  could 
be  effected. 

Chairman  Pepper.  Just  one  question  before  the  other  Congressmen 
inquire. 

Mr.  Jaffe,  would  it  be  possible  to  develop  any  sort  of  technical 
method  by  which  you  could  detect  the  conversion  of  morphine  base 
into  heroin  as  it  takes  place  in  the  laboratories  of  southern  France  by 
flying  over  the  area  where  the  laboratories  are  located? 

Mr.  Jaffe.  Yes ;  I  think  there  is  at  least  a  sufficiently  good  chance 
of  that  being  done  so  that  it  deserves  more  attention  than  it  seems  to 
be  getting. 

Yes;  as  Dr.  Yondorf  is  saying,  that  would  be  susceptible  to  counter- 
measures,  and  one  gets  into  this  problem  which  the  military  faces,  of 
countermeasures  and  counter-countermeasures.  But  I  don't  think  that 
is  a  sufficient  argument  not  to  take  the  first  step ;  that  is,  for  us  to  take 
the  initiative  in  trying  to  locate  those  laboratories,  especially  from  the 
air. 

Chairman  Pepper.  Mr.  Brasco,  do  you  have  any  questions  ? 

Mr.  Brasco.  Yes. 

I  am  sorry  I  am  late,  Dr.  Jaffe.  This  is  rather  interesting. 

I  didn't  get  a  chance  to  go  through  the  beginning — that  we  do  have 
at  this  time  such  devices  or  are  you  suggesting  the  $10  million  go  into 
the  research  and  developinent  of  such  devices  ? 

Mr.  Jaffe.  I  am  saying  that  there  is  a  very  limited  effort  under 
way  on  the  development  of  such  methods. 

Mr.  Brasco.  But  we  don't  have  the  devices  that  you  are  speaking 
about  ? 

Mr.  Jaffe.  Generally  not  of  the  various  things  I  have  spoken  about. 
Generally  they  are  not  available  in  an  operational  sense.  They  are  not 
being  used  on  the  street  by  enforcement  agencies. 

Mr.  Brasco.  This  $10  million  that  you  were  speaking  about  is  the 
cost  of  the  entire  project?  Is  that  the  cost  for  the  entire  project,  as 
you  set  forth  in  your  summary ;  that  is,  locating,  detecting,  developing 
the  dragnet  work  and  improving  the  resource  management? 

Mr.  Jaffe.  Yes;  provided  that  you  understand  that  that  does  not 
mean  it  includes  the  operational  costs,  the  cost  of  using  it.  That  figure 
is  the  cost  of  a  research  and  development  program  that  should  produce 
such  results. 

Mr.  Brasco.  I  understand.  Now,  what  would  then  be  the  cost  after 
it  is  produced,  if  you  have  any  idea,  of  putting  it 

Mr.  Jaffe.  That  is  really  a  little  bit  out  of  my  realm,  and  I  don't 
know.  For  example,  if  we  developed  a  technique  for  overflying,  what 
it  costs  to  run  an  aircraft  for  an  hour  I  really  don't  know.  But  it 
would  be  that  sort  of  thing. 

Mr.  Brasco.  How  long,  if  you  had  the  $10  million,  do  you  think  it 
might  take  to  develop  such  a  program  ? 


94 

Jaffe.  Well,  there  would  be  some  immediate  results  or  very  early 
results,  and  they  would  be  distributed. 

Mr.  Brasco.  I  know  you  said  5  years,  but  are  you  saying  it  is  5  years 
before  any  of  the  equipment  could  be  used  ? 

Mr.  Jaffe.  I  use  tlie  5  years  only  as  a  way  of  averaging  cost. 
There  is  no  significance  in  the  5  years,  in  terms  of  when  results 
would  be  available.  I  would  expect  there  to  be  a  stream  of  results 
over  a  longer  period  of  time,  too.  Just  as  a  way  of  averaging  the  cost 
I  say  I  think  that  the  program  might  run  something  like  $10  million 
over  a  5-year  period.  If  you  like,  say  an  average  of  $2  million  a  year 
or  something  like  that. 

Mr.  Brasco.  I  wasn't  inquiring  so  much  about  the  money.  I  was  con- 
cerned about  when  it  might  be  operational. 

I  am  trying  to  find  out  when  you  would  have  a  system  that  you  are 
talking  about?  I  am  not  trying  to  pin  you  down,  just  trying  to  get 
an  idea. 

Mr.  Jaffe.  I  think  it  might  be  as  early  as  a  year  before  we  can  spot 
poppyfields  from  the  air,  or  a  fraction  of  a  year,  within  a  year. 

Some  of  the  other  techniques,  the  establishment  of  a  model  for 
example,  and  the  operation  of  that,  generally  takes  longer  because 
there  are  long  periods  .of  validation  necessary  while  you  test  the  thing 
out  and  make  sure  you  got  the  right  model. 

So  there  are  differences.  I  think  that  sensors,  for  example,  might 
run  1  to  2  years,  something  in  that  period,  or  even  less. 

Chairman  Pepper.  Dr.  Yondorf  ? 

Dr.  YoNDORF.  Thank  you,  Mr.  Chairman. 

I  would  suggest  that  sensing  from  satellites  would  require  much 
more  development.  It  is  easier  with  our  pjresent  technology  to  identify 
poppyfiields  with  airborne  sensing  equipment;  that  is,  with  minor 
adaptations  of  sensor  equipment  now  existing  on  aircraft.  On  the 
political  problems  of  flying  over  foreign  territory  with  aircraft,  you 
are  more  expert  than  I  am,  but  technically  this  is  where  one  should 
start.  Sensors  aren't  sufficiently  discriminating  now  to  identify  crops 
from  very  great  altitudes.  Research  and  development  money  initially 
should  be  spent  to  develop  more  sensitive  sensors  and  test  them  out. 

Mr.  Brasco.  Thank  you. 

Chairman  Pepper.  Mr.  Wigsins. 

Mr.  Wiggins.  I  have  no  ouestions,  Mr.  Chairman. 

Chairman  Pepper.  Mr.  Mann. 

Mr.  Maxn.  You  imply  that  the  governmental  efforts  beins:  made 
now  in  these  areas  are  minimal.  Are  they  doing  anything  with  refer- 
ence to  opium  crop  detection  capabilities,  sensor  devices? 

Mr.  Jaffe.  Yes;  they  are.  In  fact,  with  the  exception  of  the  data 
bank  on  which  I  was  not  able  to  uncover  anything,  something  is  being 
done  in  each  of  the  other  areas.  There  is  something  being  done  on  the 
question  of  surveillance  from  the  air,  and  some  of  the  others — the 
sensors  and  tracers,  too.  There  is  some  very  limited  modeling  going  on. 

Mr.  Mann.  Dr.  Yondorf,  you  sujrgested  that  aircraft  surveillance 
to  develon  the  techniques  is  a  preliminary  step  to  developing  a  satel- 
lite capability. 

Do  you  think  a  satellite  capability  is  possible  ? 

Dr.  Yondorf.  We  do  think  it  is  possible.  It  is  just  a  matter  of  refin- 
ing existing  techniques.  Of  course,  one  can  ai-gue  Ihon  from  which 


d5 

altitude  the  satellites  should  operate.  We  have  satellites  that  go  up 
to  22,000  miles— synchronic  altitude— and  it  probably  is  extremely 
difficult  to  see  poppies  from  that  altitude. 

But  low  altitude  satellites  might  well  attain  the  discrimination  one 
would  need  for  this  purpose. 

Mr.  Mann.  Mr.  Jaffe,  are  you  aware  of  any  aerial  surveillance,  aerial 
efforts  made  by  the  United  States  of  poppyfields? 

Mr.  Jafte.  No  ;  and  those  who  are  in  a  lot  better  position  to  have 
heard  of  any  such  things  tell  me  that  they  are  99  percent  sure  that 
there  is  no  such  thing  in  existence.  To  date,  no  aerial  surveillance  has 
been  made  of  poppyfields. 

Mr.  Mann.  Well,  is  my  information  correct  that  there  are  poppy- 
fields in  areas  of  this  world.  Southeast  Asia,  for  example,  where  we 
have  a  lot  of  aircraft  operating  ? 

Mr.  Jaffe.  That  is  true. 

Mr.  Mann.  No  further  questions. 

Chairman  Pepper.  Mr.  Steiger. 

Mr.  Steiger.  Thank  you,  Mr.  Chairman. 

Just  a  couple  of  questions,  Mr.  Jaffe. 

Incidentally,  I  for  one  find  your  presentation  very  interesting  as 
opposed  to  my  colleagues'  rather  casual  interest.  I  wonder  if  you  have 
heard  of  the  work  of  Joe  Zabitzi — and  I  can't  tell  you  how  to  spell  it, 
He  works  for  the  USGS  and  has  developed  infrared  photography  pri- 
marily in  the  search  of  water  resources  and  has  developed 

Mr.  Jaffe.  I  have  heard  of  the  work  they  are  doing,  but  the  name  is 
not  familiar. 

Mr.  Steiger.  I  think  it  might  be  of  interest  for  you  gentlemen  to 
coordinate  with  him  because  he  has  done  some  very  dramatic  things 
I  have  seen,  and  obviously,  it  coincides  completely  with  the  type  of 
thing  you  are  doing  here.  I  know  you  are  aware  of  this,  but  I  think 
the  record  should  reflect  your  awareness,  since  your  statement  does  not. 

In  all  your  research  and  development  I  would  assume  you  would 
suggest  the  need  for  security,  even  in  the  research  and  development 
phase,  so  as  to  at  least  minimize  the  opportunity  for  the  countermeas- 
ures  you  referred  to  ? 

Mr.  Jaffe.  Absolutely ;  yes.  I  certainly  agree  with  that. 

Mr.  Steiger.  I  say  this  because,  interestingly  enough,  Mr.  Zabitzi 
recited  to  me  a  proposal  by  a  gentleman  from  the  private  sector,  I 
believe  would  be  a  friendly  way  of  saying  it,  who  asked  him  if  he 
could  find  poppyfields  for  him.  He  was  on  a  United  Nations  mission 
in  North  Africa,  and  he  was  asked  if  his  technique  would  show  up 
poppyfields. 

This  fellow,  who  said  he  was  a  horticulturist,  which  I  thought  was 
interesting,  indicated  that  he  would  be  willing  to  pay  for  the  informa- 
tion as  to  the  location  of  the  poppyfield. 

So  there  is  an  awareness  among  the  group. 

Mr.  Wiggins.  Horticulturists  ? 

Mr.  Steiger.  Among  the  horticulturists. 

That  is  all,  Mr.  Chairman. 

Chairman  Pepper.  Mr.  Rangel. 

Mr.  Rangel.  Mr.  Jaffe,  in  the  course  of  your  studies,  upon  what  do 
you  base  the  assumption  that  the  United  States  does  not  know  where 
these  opium  crops  are  located  or  where  the  laboratories  are  ? 


96 

Mr.  Jaffe.  Primarily  on  the  fact  that  there  seems  to  be  more  than 
casual  interest  among  the  enforcement  agencies  in  techniques  of  this 
sort  when  we  do  talk  to  them  about  these  things.  From  the  fact  that 
they  have  some  ongoing  programs  in  these  areas,  one  would  assume 
that  they  don't  know  precisely  where  the  fields  are  or  where  the  labora- 
tories are.  And  it  is  just  information  of  which  I  don't  have  firsthand 
knowledge,  but  I  think  pretty  good  secondhand  knowledge. 

Mr.  Rangel.  Well,  in  view  of  the  fact  that  we  have — at  least  I  think 
we  can  admit  we  have — U-2  surveillance  aircraft,  we  have  been,  able 
to  detect  missiles  in  Cuba,  we  have  been  able  to  determine  areas  of 
vegetation  in  Vietnam  and  Korea  before  this,  and  in  view  of  the  fact 
rhat  we  have  a  very  close  economic  relationship  with  the  countries  that 
we  are  mentioning  that  are  considered  to  be  friendly  to  us,  and  so 
therefore  there  is  an  assumption  that  Government  is  cooperating  with 
us,  it  seems  to  me  that  all  of  the  information  would  lead  us  to  believe 
that  we  know  exactly  where  the  crops  are  located  and  where  the  labora- 
tories are. 

Mr.  Jaffe.  I  think  there  is  a  difference  between  knowing  generally 
where  they  are  and  knowing  specifically  where  they  are.  It  strikes 
me  that  that  really  is  the  difference  that  we  would  be  getting  at  with 
technology. 

Mr.  Rangel.  Well,  have  you  studied  any  of  the  reports  of  the  sophis- 
tication of  our  U-2  aircraft  ? 

Mr.  Jaffe.  Well,  I  know  generally  about  what  they  can  do,  about 
their  operational  capabilities. 

Mr.  Rangel.  And  the  information  has  been  rather  specific  ? 

Mr.  Jaffe.  Yes. 

Mr.  Rangel.  And  if  we  can  send  these  aircraft  over  unfriendly  na- 
tions, I  just  presume  we  can  send  them  over  friendly  nations. 

Mr.  Jaffe.  I  would  agree. 

Mr.  Rangel.  And  if  we  can  do  all  of  this  I  presume  that  we  have 
the  knowledge  that  we  want  already. 

Mr.  Jaffe.  I  can't  disagree  with  your  presumption.  The  informa- 
tion I  have  is  that  the  locations  are  not  precisely  known  over  a  period 
of  time.  Obviously  if  they  detect  one,  if  they  find  it,  they  know  where 
that  one  is,  but 

Mr.  Rangel.  If  my  presumptions  are  correct,  we  don't  need  any  more 
research  and  development? 

Mr.  Jaffe.  The  location  of  a  laboratory,  for  example,  from  the  air, 
does  require  additional  research  and  development.  There  is  no  suitable 
way  at  the  moment  of  overflying  or  finding  a  laboratory. 

Mr.  Rangel.  We  can  find  missile  bases  but  we  can't  find  laboratories  ? 

Mr.  Jaffe.  Correct;  because  the  laboratory,  from  the  air,  looks  like 
nothing  more  or  less  than  an  ordinary  house,  somebody's  private  home. 

Mr.  Rangel.  Even  with  information  given  to  us  by  so-called 
friendly  nations  ? 

Mr.  Jaffe.  Well,  I  don't  know  about  that  part  of  it. 

Mr.  Rangel.  Well,  let  me  ask  you  one  last  question,  Mr.  Jaffe.  As- 
suming that  we  did  get  the  refined  sophisticated  type  of  research  and 
development  that  you  are  suggesting;  after  we  got  it,  what  would  you 
suggest  we  do  with  it  ? 

Mr.  Jaffe.  AVell,  all  through  my  remarks  I  stressed  the  need  to  have 
the  research  and  development  program  aimed  at  the  operational  needs 


97 

of  the  enforcement  agencies.  So  presumably,  the  output  would  be  some- 
thing which  is  immediately  operationally  useful  to  an  enforcement 
officer. 

The  next  step,  then,  would  be  to  turn  it  over  to  him  and  let 
him  use  it. 

Mr.  Rangel.  Have  any  of  the  law  enforcement  agencies  in  the  United 
States  ever  requested  this  type  of  support  that  you  know  of  ? 

Mr.  Jaffe.  Yes.  They  have  ongoing  programs,  and  I  have  discussed 
with  them  the  magnitude  of  those  programs.  I  think  I  can  say  that 
there  is  a  need  and  they  would  agree  to  a  need — not  everyone,  you 
know,  of  course.  If  you  talk  to  the  guy  about  his  little  laboratory  he 
says  this  is  fine,  this  is  my  kingdom. 

Mr.  Rangel.  Is  there  any  agency  that  has  a  mandate  to  eradicate  the 
international  trafficking  of  drugs,  that  has  gone  on  record  in  asking 
for  more  Federal  assistance  in  the  area  you  have  testified  to  ? 

Mr.  Jaffe.  I  don't  know.  I  really  don't  know. 

Mr.  Rangel.  Thank  you. 

Chairman  Pepper.  Excuse  me  just  1  minute. 

Mr.  Jaffe,  as  I  understood  the  import  of  your  testimony,  you  were 
assuming  that  if  we  had  an  international  treaty  or  agreement  that 
would  ban  the  growing  of  the  opium  poppy  then  if  somebody  were 
to  plant  a  field  of  opium  poppies  it  could  be  detected  by  surveillance 
methods  so  that  the  policing  could  be  effective  ? 

Mr.  Jaffe.  That  is  exactly  right. 

Chairman  Pepper.  Is  your  information  the  same  as  mine,  that  these 
laboratories  in  southern  France  are  moved  around  from  place  to  place, 
from  time  to  time,  so  there  is  no  fixed  location? 

Mr.  Jaffe.  That  is  true.  They  do  move  quite  a  bit.  Some  of  them  are 
easily  knocked  down  and  set  up  again  somewhere  else. 

Mr.  Mann.  To  that  may  I  make  a  statement  ? 

Chairman  Pepper.  Go  right  ahead. 

Mr.  Mann.  I  was  in  Paris  last  week  where  I  conferred  with  the 
director  of  the  National  Police  Force,  a  representative  of  the  BXDD 
in  Paris,  and  I  came  away  persuaded  that  France  is  making  every 
effort  in  cooperating  with  us  and  the  law  enforcement  arena  to  un- 
cover the  laboratories,  that  there  is  no  reluctance  on  their  part  or  no 
economic  considerations  on  their  part  that  are  interfering  with  their 
cooperation  in  attempting  to  uncover  these  laboratories. 

Chairman  Pepper.  Mr.  Winn. 

Mr.  Winn.  Thank  you,  Mr.  Chairman. 

Mr.  Jaffe,  your  statement  intrigues  me,  partly  because  I  am  on  the 
Science  and  Astronautics  Committee  and  I  am  aware  of  the  work  that 
has  been  done  in  the  satellites  and  sensors  by  ERTS.  How  much  work 
have  you  actually  done  on  the  feasibility  of  the  total  systems 
approach  ? 

In  other  words,  have  you  taken  each  of  the  suggested — like  the 
laboratory  detection  tracers,  sensors — have  you  actually  tried  to  co- 
ordinate all  that  and  put  a  package  together  ? 

Mr.  Jaffe.  No  ;  we  haven't  really  done  that  in  this  particular  case. 
Our  organization  and  others  like  it  specialize  in  doing  that  sort  of 
thing,  but  in  this  particular  application  we  haven't  yet  done  that. 

Mr.  Winn.  Well,  I  don't  mean  to  be  rude  about  that,  but  I  gather 
that  from  your  guess  of  $10  million,  because  I  don't  think  you  are 


98 

in  the  same  ball  park  about  what  it  would  cost.  But  that  is  ray  own 
opinion. 

I  do  think  you  are  on  the  right  track,  and  I  wish  possibly  some- 
where m  your  realm  you  would  try  to  coordinate  more  closely  these 
potentials. 

I  don't  really  care  whether  any  law  enforcement  agencies  in  this 
country  or  the  world  have  asked  you  to  do  it. 

I  would  hope  someone  with  your  capabilities  would  do  it,  and  there 
is  a  tremendous  need  for  it. 

Now,  on  the  satellite  capabilities,  I  have  no  doubt  that  within  a 
very  short  period  of  time— and  I  agree  with  your  time  schedule  that 
within  a  year,  we  can  view  from  the  air,  from  satellite,  the  poppy- 
fields.  Of  course,  some  one  might  get  up  on  the  floor  of  the  House  and 
say  that  their  poppyfield  had  been  bugged,  but  I  think  we  are  going 
to  have  to  use  those  approaches,  and  go  at  it  from  that  direction. 

Because  here  is  a  program  that  is  already  available  to  us,  here  is  a 
program  where  we  have  spent  millions  of  dollars  trying  to  use  the 
science  and  technology  research  capabilities  of  these  men.  These  are 
the  same  men  whom  we  are  now  putting  out  of  jobs  because  some  of 
our  programs  are  being  phased  out,  and  we  could  use  their  ability  to 
help  solve  some  of  the  drug  problems  in  the  country. 

I  think  you  are  on  the  right  track.  I  commend  you  for  your  state- 
ment and  I  hope  that  possibly  you  can  put  some  additional  informa- 
tion in  the  record  as  far  as  coordination  is  concerned. 

Thank  you  very  much. 

Chairman  Pepper.  Mr.  Keating  ? 

Mr.  Keating.  No  questions,  Mr.  Chairman. 

Chairman  Pepper.  Mr.  Brasco,  any  questions  ? 

Mr.  Brasoo.  Yes,  I  wanted  to  ask  one  question  and  make  an 
observation. 

I  heard  several  times  about  an  agreement  being  necessary,  but  it 
would  appear  to  me  if  we  are  talking  about  satellite  surveillance  I 
don't  know  if  we  need  any  agreement  to  use  that  kind  of  technique, 
and  I  think  it  makes  it  more  attractive  because  of  that  because  you 
are  apt  to  get  an  arrangement  where  you  can  perfect  the  equipment 
before  you  get  an  agreement.  But  the  one  question  I  would  like  to 
ask  in  connection  with  the  sensors  that  you  spoke  about,  which  ap- 
parently would  detect  the  drug,  you  mentioned  that  they  were  not 
of  sufficient  capability  at  this  time  to  be  possibly  used  in  satellites. 

Could  you  use  whatever  equipment  you  have  now,  and  are  they 
using  it,  anyone,  if  you  know,  at  points  of  entry  in  the  United  States 
just  to  detect  it,  if  someone  has  it,  you  know,  in  a  bag  or  on  their 
person,  or  somewhere  in  the  vicinity  of  the  airport  or  the  seaport? 

Mr.  Jaffe.  First  of  all,  there  are  really  two  different  classes  of 
things  that  we  mean  when  we  talk  about  surveillance  from  the  air  and 
sensing  at  a  point  of  entry.  The  techniques  for  detecting  opium  fields 
from  the  air  are  generally  available.  They  just  haven't  been  applied  in 
this  direction  and  haven't  been  adapted  to  this  application. 

Mr.  Brasco.  How  about  the  latter  one  that  I  was  talking  about  ? 

Mr.  Jaffe.  On  the  latter  one.  the  Bureau  of  Customs  does  have  a  pro- 
gram underway  in  that  area.  I  don't  know  of  anything  being  used  now. 
I  don't  think  anything  has  progressed  to  the  point  where  it  is  being 
used  now. 


99 

ISIr.  Brasco.  Is  that  a  possibility,  in  your  opinion,  to  develop  that 
kind  of  thing:? 

Mr.  Jaffe.  Very  much  so. 

Mr.  Brasco,  That  obviously  is  not  included  in  the  program  you  are 
talkinof  about  now ;  or  is  it  ? 

Mr.  Jaffe.  Yes ;  it  is  included  in  the  program  suggested. 

Mr.  Brasco.  How  far  might  we  be  away  from  getting  something  like 
that  effected?  I  am  talking  about — let's  take  away  the  satellites  and 
the  other  kinds  of  survellances  that  we  could  develop  something  that 
customs  agents  could  use  for  detecting  on  peojjle,  in  bags,  what  have 
you,  on  ships  coming  into  the  United  States. 

Mr.  Jaffe.  I  think  with  the  right  kind  of  program,  on  the  order  of  a 
year. 

Mr.  Brasoo.  Do  you  have  any  idea  as  to  what  that  specific  item  would 
cost,  just  that  item. 

Mr.  Jaffe.  That  is  so  hard  to  do  without  sitting  down  and  working 
it  out  for  that  particular  application. 

Anybody  want  to  guess  ? 

Mr.  Brasco.  Xo  idea  ? 

Mr.  Jaffe.  It  is  very  easy  to  say  on  the  order  of  a  half  a  million 
dollars  to  a  million  dollars,  something  like  that. 

Mr.  Brasco.  Thank  you.  Dr.  Yondorf ,  do  you  have  anything  to  add 
to  what  Mr,  Jaffe  has  said  ? 

Dr.  YoxDORF.  I  generally  agree,  but  not  with  his  numbers.  I,  person- 
ally, guess — I  haven't  made  a  survey — that  this  research  could  be  very 
much  more  expensive,  as  Mr.  Winn  has  said.  How  much  more  is  diffi- 
cult to  say.  The  sort  of  thing  one  would  try  to  permit  detection  at  entry 
gates  would  be  some  simple  thing  first,  perhaps  several  techniques  in 
the  area  of  spectrum  analysis.  If  it  doesn't  work  one  would  have  to  try 
many  other  techniques.  I  don't  think  we  have  done  enough  research, 
certainly  not  any  of  us  here,  to  have  a  very  good  feeling  of  what  mag- 
nitude of  effort  would  be  required  if  at  first  simple  things  don't  work. 

First  feasibility  tests — this  is  indeed  what  we  suggest  here — can 
be  undertaken  and  some  results  gotten  within  a  year.  But  before  one 
can  make  a  solid  estimate  as  to  how^  much  more  work  is  required  one 
has  to  have  that  feasibility  study  under  one's  belt.  We  haven't  done 
that. 

Mr.  Brasco.  Notwithstanding  disagreement  with  respect  to  the  num- 
bers, but  you  do  agree  with  Mr.  Jalfe's  position  that  it  can  be  done? 

Dr.  Yondorf.  That  can  be  done ;  yes. 

(For  more  detailed  statement  concerning  proposed  research  and  de- 
velopment program  see  exhibit  Xo.  8(a)  page  101.) 

Chairman  Pepper.  Mr.  Holden,  would  you  add  anything? 

Mr.  Holden.  Perhaps  just  a  statement  in  regard  to  Mr.  Rangel's 
point  that  the  militaiy  has  been  flying  IJ-2's  all  over  the  world  and 
satellites  surveying,  apparently,  anything  of  interest.  So  why  haven't 
we  done  this — located  illicit  poppyfields?  It  is  a  question  of  where 
we,  as  a  government,  point  our  cameras  find  which  budget  pays  for 
what  type  of  surveillance  coverage. 

It  is  obvious  the  military  has  done  a  lot  of  work  in  this  area  of 
aerial  and  spatial  surveillance.  The  point  here  is  that  this  activity 
ought  to  receive  its  fair  share  of  the  budget  to  apply  survellance  tech- 
niques to  the  fight  on  drug  abuse. 


100 

Chairman  Pepper.  Mr,  Waldie,  do  you  have  a  question? 

Mr.  Waldie.  Well,  Mr.  Chairman,  I  am  intruding  in  a  conversation 
that  has  already  occurred,  but  it  seems  to  me  that  to  invest  any  great 
sums  of  money  in  surveying  that  area  of  the  globe  where  opiimi  is 
being  grown  is  moving  to  the  problem  in  the  wrong  way.  We  know 
where  opium  is  being  grown.  It  is  being  grown  in  Laos.  It  is  being 
grown  in  Burma.  It  is  being  grown  in  Turkey. 

It  has  not  been  a  problem  of  identifying  where  the  fields  are.  It  is 
getting  those  who  grow  the  opium  to  curtail  production  of  it.  Their 
failure  to  curtail  production  has  not  been  a  failure  on  their  part  to 
identify  where  it  is  being  grown. 

It  would  seem  to  me  that  money  ought  to  be  spent,  first,  to  get 
willingness  on  the  part  of  the  governments  that  own  the  land  on 
which  the  opium  is  being  grown  to  embark  upon  a  program  of  eradica- 
tion and  then,  perhaps,  to  a  system  in  identifying  the  areas  in  which 
eradication  is  necessary. 

I  don't  think  there  is  any  problem  of  identifying  Laotian  opium. 
It  is  participated  in  by  the  Laotian  Government.  They  are  profiting 
from  it.  Burma  opium  crops  are  not  any  secret ;  neither  are  the  Turkey 
opium  crops.  I  just  am  not  quite  certain  why  we  would  invest  any 
money  in  aerial  surveillance  to  determine  where  the  fields  are  that  are 
growing  opium  at  this  point. 

Chairman  Pepper.  I  think,  perhaps,  you  didn't  get  the  assumption. 

Mr.  Jaffe  would  you  state  what  the  assumption  was  upon  which  you 
recommend  the  use  of  these  detection  devices  for  growing  poppyfields  ? 

Mr.  Jaffe.  First  of  all,  the  idea  that  there  is  no  one  route,  there  is 
not  lust  one  thing  that  needs  to  be  done  and  that  the  aerial  surveillance 
of  the  opium  fits  into  a  total  scheme  of  things  which  would  include 
such  things  as  international  agreements,  which  would  then  have  to  be 
enforced,  and  violations  of  that  treaty  would  have  to  be  detected. 
From  there  we  get  to  the  aerial  surveillance.  That  is  one  route,  to  get 
to  the  aerial  surveillance. 

But  it  is  within  the  total  scheme  of  things,  we  think,  that  aerial  sur- 
veillance plays  a  part.  I  would  agree  that  in  the  case  of  Laos  there  may 
be  no,  or  very  little  reason  to  want  to  know  where  each  field  is 
precisely. 

But  I  think  the  reasons  in  Turkey  and  other  countries  that  are 
closer  and  friendly,  the  reasons  become  somewhat  more  compelling. 
It  is  one  thing  to  have  an  agreement  from  them  to  limit  the  growth  of 
opium.  It  is  another  thing  to  be  sure  that  it  is  actually  happening  and 
to  know  where  it  is  and  isn't  happening. 

It  is  in  that  context  that  we  propose  to  use  it. 

Chairman  Pepper.  Gentlemen,  if  I  understand  it,  you  surmise,  as  did 
Assistant  Secretary  of  the  Treasury  Rossides.  that  the  bringing  in  of 
heroin  to  this  country  is  effectuated  largely  by  an  international  con- 
spiracy of  people  who  are  perpetrating  that  crime  in  order  to  make 
hundreds  of  millions,  if  not  billions  of  dollars,  a  year.  They  are  ruth- 
less, they  are  well  organized,  they  are  ably  directed. 

In  other  words,  it  is  a  criminal  conspiracy  of  great  magnitude. 

You  are  suggesting  that  if  we  are  to  be  effective  against  that  kind 
of  an  international  conspiracy  to  bring  opium  into  this  country  and 
distribute  it  we  must  employ  or  we  should,  to  be  most  effective,  employ 
the  most  modwn  techniques  and  the  most  comprehensive  program  for 
dealing  with  it ;  is  that  the  theme  of  your  statement  ? 


101 

Mr.  Jaffe.  I  think  it  is  a  very  precise  statement  of  the  case. 

Chairman  Pepper.  Thank  you  very  much. 

Have  you  anything  for  the  record,  Mr.  Perito  ? 

Mr.  Perito.  Yes,  Mr.  Chairman. 

May  we  place  in  the  record  the  supplemental  statement  and  curric- 
ulum vitae  of  Mr.  Jaffe;  also,  the  prepared  statement  of  Mr.  William 
S.  Ulrich,  which  was  unfortunately  omitted  from  our  New  York  hear- 
ings, but  relates  to  the  statements  made  by  Mr.  Jaffe,  Dr.  Yondorf, 
and  Mr.  Hoi  den. 

Chairman  Pepper.  Without  objection,  they  will  be  received. 

(The  material  referred  to  follows:) 

[Exhibit  No.  8(a)] 

Supplemental  Statement  of  David  Jatfe,  Department  Staff,  MITRE  Corp. 

The  suggested  research  and  development  program  consists  of  five  major  parts. 
In  what  follows,  each  part  is  further  defined  in  terms  of  tasks,  products,  and 
probable  cost.  The  cost  estimates  are  related  to  performance  periods,  as 
appropriate. 

The  structure  of  these  efforts  is  highly  variable,  and  the  corresponding  per- 
formance period  and  cost  will  be  sensitive  functions  of  the  approach  selected. 
A  conservative  approach  can  be  taken  in  which  ideas  are  investigated  one  at  a 
time,  or  a  redundant  program  can  involve  several  simultaneous  efforts  with  the 
same  objective.  The  cost  estimates  given  below  are  for  conservative  approaches. 
They  are  subject  to  considerable  flexibility  and  interpretation  and  should  be 
taken  as  gross  values  appropriate  only  for  initial  planning. 

(1)  Surveillance  of  Opium  Poppy  Crops 

An  initial  experiment  would  establish  the  basis  for  assembly  of  test  apparatus. 
After  evaluation  of  the  test  gear,  designs  would  be  finalized  and  prototype  equip- 
ment, suitable  for  aircraft-bome  operation,  would  be  constructed  and  tested. 
Culminating  in  delivery  of  the  prototype  instrument  with  operating  procedures, 
this  effort  might  cost  about  $2.5  million  and  take  1  to  2  years.  The  prototype 
instrument  would  be  suitable  for  use  by  operational  agencies  in  verifying  func- 
tional utility  and  in  specifying  future  procurements. 

Satellite  observations  would  at  first  make  use  of  data  from  available  instru- 
ments. Only  then  could  the  possible  need  for  special  hardware  be  determined. 
Depending  on  the  results  of  initial  experimentation,  this  project  could  cost 
between  $500,000  and  $2  million.  The  lower  figure  presumes  ability  to  use  avail- 
able data ;  the  higher  one  would  be  the  cost  of  a  special  instrument  package 
suitable  for  flight  on  a  satellite. 

(2)  Tracer  Technology 

This  effort  would  consist  of  identifying  tracer  materials  which  could  be  used 
in  a  variety  of  operational  situations.  Contracts  would  be  let  to  chemical  research 
firms  to  develop  specific  tracers  which  would  be  subjected  to  tests  for  suscepti- 
bility to  detection  and  countermeasures.  The  product  of  this  effort  would  be 
recommendations  to  the  enforcement  agencies  for  use  of  a  variety  of  tracers. 
Costs  are  estimated  at  $1.5  million  over  a  2-  to  3-year  period. 

(3)  Sensor  Technology 

Techniques  known  to  be  capable  of  identifying  heroin  would  be  rated  as  to 
their  potential  for  meeting  the  constraints  of  the  operational  situations.  Con- 
tracts would  be  let  for  redesign  of  the  two  best  possibilities  and  for  tests  of 
techniques  which  might  prove  to  be  applicable.  Prototypes  of  the  most  promising 
designs  would  be  constructed,  tested,  and  made  available  to  enforcement  agencies. 
A  continuing  effort  would  be  devoted  to  finding  additional  useful  concepts  and 
designs.  In  a  5-year  period,  it  is  expected  that  three  or  four  prototypes  would 
be  completed  at  a  total  cost  of  about  $4  million. 

(4)  Data  Handling 

A  computerized  data  bank  would  be  designed  using  information  on  all  facets 
of  illicit  drug  production,  distribution,  use,  and  control.  Information  to  be  in- 
cluded would  be  determined  by  the  operational  requirements  of  the  enforcement 


102 

agencies  and  input  data  would  be  supplied  by  those  agencies.  The  agency  charged 
with  maintaining  the  data  bank  would  be  provided  with  a  complete  system 
design,  including  performance  specifications  for  hardware  and  software.  They 
would  also  receive  technical  assistance  during  the  implementation  and  testing 
phases.  Total  cost  of  this  effort  is  estimated  at  about  $1  million. 

(5)  Netivork  Modeling 

Drug  production  and  distribution  networks,  and  their  economic  systems,  will 
be  simulated  by  mathematical  relationships  and  other  representations.  The 
models  will  be  operated  to  reveal  sensitivities  and  vulnerabilities  of  the  illicit 
trade.  This  project  is  viewed  as  a  joint  effort  by  the  model  developers  and  a 
user  agency  for  5  years,  after  which  the  model  will  be  run  entirely  by  the  agency. 
The  5-year  cost  above  the  normal  agency  costs  will  total  about  $1  million. 


[Exhibit  Xo.  8(b)] 
Curriculum  Vitab  of  David  Jaffe,  Department  Staff,  MITRE  Corp. 

EDUCATION 

Brooklyn  College,  B.S.,  1951,  physics  and  math. 
University  of  Connecticut,  M.S.,  1952,  physics  and  math. 

Additional  graduate  courses  in  solid  state  physics,  mathematical  statistics,  and 
magnetic  resonance. 

EXPERIENCE 

The  MITRE  Corp.,  September  1970  to  present : 

Department  staff.  Concerned  with  the  application  of  technology  to  criminal 
justice  systems.  Communications,  information  systems,  sensors  and  alarms,  and 
specialized  technology  are  the  subjects  of  these  efforts.  Methods  of  approach 
include  operations  analysis  and  systems  engineering. 

Research  Analysis  Corp.,  October  1965  to  September  1970 : 

Deputy  head,  public  safety  department.  Developed  program  concepts  for 
research  in  law  enforcement  and  the  administration  of  justice.  Directed  studies 
including  the  relationship  between  the  physical  environment  and  crime  rates, 
logistic  support  to  police  and  fire  departments  in  combating  civil  disorders,  the 
development  of  specifications  for  techniques  and  devices  in  the  prevention  of 
burglary,  the  role  of  the  police  in  a  ghetto  community,  and  others. 

As  deputy  department  head  of  RAC's  unconventional  warfare  department, 
conducted  studies  of  dissident  and  insurgent  grouns.  their  modes  of  operation, 
and  their  vulnerabilities.  Assessed  national  threats  from  internal  and  external 
population  segments.  Investigated  the  feasibility  of  techniques  designed  to 
measure  magnitudes  of  insurgent  activities. 

American  Machine  d  Foundry  Co.,  Alexandria  Division,  1959  to  1965: 

Assistant  manager,  space  instrumentations  department.  Directed  the  re- 
research  and  development  activities  of  about  30  men.  This  group,  consisting  of 
physicists,  electronic  engineers,  and  mechanical  designers  as  well  as  support  per- 
sonnel, specialized  in  the  conception,  design,  development,  fabrication,  and  test- 
ing of  scientific  instrumentation,  primarily  for  use  on  satellites  and  rockets. 
Areas  of  primary  competence  include  X-ray.  optical,  and  microwave  instrumen- 
tion  and  measurements.  A  major  nroject  was  the  design  and  constrnrtion  of  soft 
X-ray  solar  spectrometers  for  flight  on  Aerobee  rockets  and  the  OSO  series  of 
satellites. 

As  head  of  physics  section,  directed  experimental  and  development  programs 
in  general  phvsics.  iuf'luding  classical  and  quantum  disciplines.  Tvnimi  pro- 
grams were  the  investigation  of  gaseous  microwave  spectroscopy  involving  ex- 
tremely sensitive  receivers ;  visible  signals  in  space,  their  sources,  and  their 
interactions:  develonment  of  specialized  ontical  and  electro-ontiral  sy--tenis  and 
instrumentation:  ion  and  atomic  beams  for  space  communication:  parametric 
amplifiers:  the  generation  of  submillimeter  waves:  standardization  measure- 
ments on  microwave  components:  microwave  attenuation  in  dielectric  materials. 

Diamond  Ordnance  Fuze  Lahnrntoric^.  iri">  to  1959. 

Conducted  theoretical  and  experimental  studies  of  the  behavior  of  ferromag- 
netic materials  at  microwave  frequencies.  Investigated  ferromagnetic  resonance 
in  ferrite  and  garnet  materials  to  develop  a  microwave  detector.  Measured  the 


103 

magnetostrictive  behavior  of  ferrites.  Made  infrared  measurements  of  ferrite 
materials. 

Ballistic  Research  laboratories,  1953  to  1955  : 

Employed  high  resolution  radioactive  tracer  techniques  in  the  investigation  of 
internal  ballistic  effects.  Designed  and  constructed  scintillation  and  photomulti- 
plier  systems  for  detection  and  location  of  radioactive  sources. 

Naval  Ordnance  Laboratory,  1952  to  1935  : 

Designed  tests  and  associated  equipment  for  the  evaluation  of  electronic  and 
magnetic  underwater  ordnance  components.  Included  were  opertaional,  life,  and 
environmental  tests.  Designed  an  automatic  and  fast-operating  open-circuit  tester 
for  a  complex  cable  harness. 

HOXORS 

Sigma  Pi  Sigma  (physics) . 

PUBLICATIONS 

D.  Jaffe,  J.  C.  Cacheris,  and  N.  Karayianis,  "Ferrite  Microwave  Detector," 
Proc.  IRE,  46  (3)  :  594-601,  March  1958. 

D.  Jaffe,  Cacheris,  and  Karayianis,  "Detection  of  High-Power  Microwaves  by 
Ferrites  and  Garnets,"  Diamond  Ordnance  Fuze  Laboratories,  TR-867,  Wash- 
ington, D.C. 

D.  Jaffe  et  al.,  "Some  Aspects  of  Indicator  Analysis,"  Research  Analysis  Corp., 
RAC-S-1900,  McLean,  Va.,  1966. 

Other  reports  classified  or  proprietary. 


[Exhibit  No.  9] 

Prepared  Statement  of  William  F.  Ulrich,  Ph.  D.,  Manager,  Applications 
Research,  Scientific  Instruments  Division,  Beckman  Instruments,  Inc., 
Dated  June  27,  1970 

Scientific  methods  have  numerous  applications  in  law  enforcement  programs 
including  the  detection  and  determination  of  narcotics  and  dangerous  drugs.  Yet, 
utilization  of  modern  technology  still  falls  short  of  its  potential  in  this  field.  I 
appreciate  the  opportunity  to  comment  on  this  point  and  to  discuss  areas  in  which 
positive  action  might  be  taken. 

To  a  large  extent  my  remarks  are  based  upon  discussions  with  individuals 
from  various  law  enforcement  agencies  throughout  the  country.  Almost  without 
exception,  these  people  have  been  cordial  and  most  helpful  in  describing  the 
needs  and  practices  in  their  diverse  operations.  From  their  comments  it  is  obvious 
that  narcotics  and  dangerous  drugs,  which  only  a  few  years  ago  were  encoun- 
tered rather  infrequently,  now  represent  a  major  factor  in  their  daily  workloads. 
Furthermore,  the  problem  is  not  restricted  to  major  population  centers  but  can 
be  found  in  virtually  all  sections  of  the  country.  To  combat  this,  mre  effective 
methods  are  needed  for  handling  the  large  number  of  samples  processed  each 
day.  Even  more  desirable  is  the  development  of  new  technology  which  will  pro- 
vide an  effective  means  for  halting  production  and  preventing  distribution  of 
illicit  materials. 

In  evaluating  technology  in  this  regard,  several  distinct  areas  merit  consider- 
ation. The  first  and  perhaps  simplest  of  these  is  to  improve  the  utilization  of 
techniques  and  methods  which  have  already  been  developed  within  this  field. 
In  an  age  when  communications  permit  instant  transmittal  of  information  and 
computers  can  be  used  for  storage  and  retrieval,  much  of  the  technical  informa- 
tion within  the  law  enforcement  field  still  follows  a  relatively  slow  and  haphaz- 
ard path.  Several  publications  are  devoted  to  this  purpose  but  even  with  these 
information  is  often  delayed.  Even  worse  is  the  fact  that  much  of  the  infor- 
mation either  is  not  published  at  all  or  is  published  in  journals  or  internal  publi- 
cations which  are  not  readily  available  to  other  workers.  Certainly  this  is  not 
an  insurmountable  problem  but  it  does  require  an  organized  program  which 
w^ould  encompass  all  efforts  in  this  field. 

A  related  area  to  be  considered  is  the  utilization  of  technology  developed  in 
other  disciplines.  Many  of  the  techniques  and  metbod^  applied  for  the  life 
sciences,  space  research,  environmental  control,  and  other  areas  can  serve 
equally  well  in  the  law  enforcement  field.  In  fact,  this  has  been  the  basis  for 
much  of  the  technology  now  in  use.  However,  for  this  to  be  truly  effective, 
greater  contact  with  these  disciplines  must  be  fostered. 

In  both  of  these  areas,  there  should  be  greater  opportunity  for  law  enforce- 
ment scientists  to  devote  time  to  development  efforts.  With  present  workloads. 


104 

most  facilities  are  barely  able  to  handle  daily  problems  let  alone  give  thought 
and  attention  to  new  and  improved  methodology.  Only  a  relatively  few  lab- 
oratories are  able  to  do  this  type  of  work  and  even  in  these  much  of  the  effort 
is  performed  on  an  ott-huurs  basis.  Until  this  situation  is  improved,  technical 
advancements  will  be  slow  and  inefficient. 

In  assessing  opium  products,  more  specific  objectives  can  be  considered.  Es- 
sentially, this  market  can  be  described  on  the  basis  of  classical  supply  and  de- 
mand principles.  Greater  control  can  be  achieved  either  by  restricting  the 
supply  or  by  decreasing  the  demand.  The  latter  involves  a  host  of  social,  en- 
vironmental, medical,  and  other  factors.  Technology  participates  in  these  but  is 
not  a  dominant  factor. 

On  the  other  hand,  scientific  methods  can  and  do  play  an  active  role  in  com- 
bating the  production  and  distribution  of  illicit  narcotics.  Current  technology 
provides  simple  and  reliable  procedures  for  identifying  and  quantitatively 
determining  these  substances  even  when  they  are  heavily  diluted  with  excip- 
ients  or  present  in  minute  quantities.  Unfortunately  these  methods  are  applicable 
mainly  to  seized  materials  and  are  relatively  ineffective  for  interception  pur- 
poses. Thus,  they  are  more  useful  for  prosecution  than  for  prevention  whereas 
ideally  the  latter  would  be  preferred.  Therefore,  more  consideration  should  be 
given  to  the  development  of  remote  sensing  and  tracer  techniques. 

In  terms  of  opium  products,  at  least  six  discrete  points  can  be  identified  where 
technology  can  be  applied  : 

(1)  The  point  of  origin;  namely,  the  naturally  occurring  or  cultivated  crop. 
This  represents  an  ideal  point  at  which  specific  tracers  could  be  added. 

(2)  The  facilities  where  the  raw  material  is  refined  and  processed  to  yield 
high-grade  morphine  and  heroin.  Surveillance  here  might  be  facilitated  by  de- 
tection of  the  chemical  reagents  utilized  or  emitted  during  processing. 

(3)  The  port  of  entry  where  the  illicit  material  is  brought  into  the  United 
States. 

(4)  The  secondary  processing  facility  where  bulk  samples  are  diluted  and 
repackaged. 

(5)  Transportation  to  the  ultimate  user. 

(6)  The  user,  his  dwelling  or  property. 

Each  of  these  represents  a  unique  set  of  circumstances  and  levels  of  difficulty. 
For  example,  chemical  detection  of  material  in  sealed  containers  is  far  more 
difficult  than  when  it  is  being  processed  or  otherwise  exposed  to  the  atmosphere. 
In  the  first  case,  it  may  be  necessary  to  open  the  container  for  detection  whereas 
in  the  latter  even  remote  sensing  is  conceivable.  In  terms  of  need,  interception 
near  the  source  is  more  desirable  than  at  the  ultimate  user  because  of  the 
quantities  involved.  The  point  to  be  made  is  that  interception  is  not  a  simple, 
single  concept  but  rather  a  set  of  individual  opportunities  each  of  which 
should  be  examined  on  its  own  merit.  Therefore,  an  approach  similar  to  that 
used  by  systems-oriented  technologists  can  be  visualized.  A  simplified  outline 
of  such  a  program  might  involve  the  following  steps  : 

(1)  Clearly  define  primary  and  secondary  goals. 

(2)  Research  and  evaluate  existing  state-of-the-art  or  level  of  knowledge 
of  the  known  and  presumed  technology  which  may  be  involved. 

(3)  Outline  all  approaches  conceivable  for  achieving  the  specified  goals. 

(4)  Evaluate  current  feasibility  of  each  approach,  the  manner  in  which  these 
interrelate,  and  the  potential  for  their  practical  application. 

(5)  Select  the  approach  or  approaches  which  should  be  pursued  as  based  on 
social  and  economic  factors  and  the  probability  of  technical  achievement. 

(6)  Design,  develop,  and  test  the  new  technology,  systems,  and  procedures 
and  apply  to  the  problem. 

(7)  Continually  evaluate  the  effectiveness  of  each  approach  to  insure  it  con- 
tinues to  move  toward  the  specified  goals  and  to  detect  new  approaches  which 
might  evolve  from  the  advancing  technology.  ,      ,  i   , 

Depending  upon  manpower  and  other  resources,  parallel  efforts  should  be 
considered  as  a  means  of  providing  answers  in  the  shortest  period.  At  the  out- 
set a  program  should  be  undertaken  to  evaluate  current  capabilities  and  knowl- 
edge which  exist  within  the  various  agencies  of  the  Federal  establishment,  inter- 
national organizations,  academic  institutions,  and  private  iiulustry  It  may  well 
be  that  technology  already  exists  for  this  purpose  and  only  needs  to  be  directed 
to  the  proper  aL^encies  for  exploitation.  At  the  very  least,  such  information  would 
be  of  considerable  value  to  law  enforcement  programs  at  all  levels  and  even  to 
external  groups  such  as  those  engaged  in  medical  research. 


105 

I  would  do  this  committee  a  serious  injustice  to  suggest  that  a  simple,  fool- 
proof detection  device  is  just  around  tlie  corner.  Ratlier,  it  seems  likely  that 
progress  will  be  made  in  orderly  steps  which  ultimately  will  provide  effective 
deterrents  to  the  illicit  traffic.  I  urge  this  committee  to  provide  support  and  en- 
couragement to  such  a  program. 

Chairman  Pepper.  Will  Dr.  Frances  Gearing  please  come  forward? 

The  committee  is  pleased  to  welcome  now  Dr.  Frances  Gearing.  In 
addition  to  her  medical  degree.  Dr.  Gearing  holds  a  master  of  pnblic 
health  degree  from  the  Columbia  University  School  of  Pnblic  Health 
and  Administrative  Medicine. 

Since  1957,  Dr.  Gearing  has  been  associated  with  the  Columbia  Uni- 
versit}'  School  of  Pnblic  Health  and  Administrative  Medicine,  where 
she  now  holds  the  rank  of  associate  professor  of  epidemiology. 

Since  1967,  Dr.  Gearing  has  served  on  the  Xew  York  State  Narcotics 
Commission's  advisory  committee  on  criteria  for  funding  narcotics 
treatment  pi-ograms.  This  year,  she  was  appointed  a  member  of  the 
professional  advisory  committee  on  heroin  addiction  of  the  District  of 
Columbia  Department  of  Human  Resources. 

Since  1965,  Dr.  Gearing  has  been  director  of  the  evaluation  unit 
for  methadone  maintenance  treatment  program  for  heroin  addic- 
tion, in  which  position  she  has  supervised  a  comprehensive  study  of  the 
efficacy  of  methadone  maintenance  and  its  relationship  to  crime  control. 

Dr.  Gearing,  we  w^elcome  your  testimony  on  this  matter  of  critical 
importance. 

Mr.  Perito,  will  you  inquire  ? 

Mr.  Perito.  Dr.  Gearing,  we  understand  that  you  have  conducted 
several  studies  on  the  relationship  between  the  use  of  the  methadone 
modality  treatment  approach  and  the  decrease  in  crime  by  addicts 
under  such  treatment ;  is  that  correct  ? 

STATEMENT  OE  DR.  FRANCES  R.  GEARING,  ASSOCIATE  PROFESSOR, 
DIVISION  OF  EPIDEMIOLOGY,  COLUMBIA  UNIVERSITY  SCHOOL 
OF  PUBLIC  HEALTH  AND  ADMINISTRATIVE  MEDICINE 

Dr.  Gearing.  Yes. 

Mr.  Perito.  I  wonder  if  you  could  review  for  the  committee  the 
approach  that  you  took  and  the  type  of  studies  that  have  been  final- 
ized by  you  or  under  your  direction. 

Dr.  Gearing.  Well,  for  the  record,  it  is  all  one  study.  It  is  a  con- 
tinuing ongoing  evaluation. 

We  have  looked  at  it  in  several  ways.  First  of  all,  we  did  before- 
and-after  pictures  of  what  has  happened  to  the  patients  who  have  been 
admitted  to  the  program,  looking  at  their  previous  criminal  records 
and  comparing  this  with  what  has  happened  to  them  since  they  have 
been  in  the  program. 

Our  latest  review  would  say  that  you  could  almost  look  at  metha- 
done as  some  kind  of  a  vaccine  against  crime  and  look  at  it  in  a  vaccine 
efficacy-type  model  and  in  that  light  we  would  say  that  methadone 
maintenance  patients  have  a  decrease  in  their  criminality  in  the  first 
year  of  81.5  percent ;  in  the  second  it  is  about  92  percent;  in  the  third 
year,  96  percent ;  and  for  those  who  stay  in  the  fourth  year,  it  comes 
close  to  99  percent.  That  is  using  the  same  patients'  previous  crim- 
inality records  as  a  basis  for  comparison. 

60-296  0—71 — pt.  1 S 


106 

We  have  also  studied  a  ^roup  of  addicts  who  have  been  admitted  to 
the  detoxification  unit  at  Morris  Burns  Institute  in  New  York  City. 
This  is  a  short-term  drym^  out  process  where  they  remain  in  the  facil- 
ity for  approximately  2  weeks,  .qfettintr  decreasing:  doses  of  methadone. 

We  matched  these  people  with  patients  in  the  studv  populaHon  and 
looked  at  their  criminal  records  pr'or  to  time  of  admission  in  detoxifi- 
cation and  what  has  happened  to  them  subsequentlv. 

The  contrast  is  rather  strikinsj.  The  detoxification  does  not  prevent 
crime.  Their  records,  since  under  our  observation,  are  no  different  than 
thev  were  prior  to  admission  for  detoxification. 

Mr.  Pertto.  Dr.  Gearina:.  how  large  a  samplinq;  did  vou  use?  Did 
you  use  the  entire  group  when  you  did  this  profile  analysis  that  you 
gave  us  from  81.5  to  99  percent? 

Dr.  Gearing.  The  figures  I  gave  you  of  the  4  years  would  be  the  first 
1,000  patients  admitted  to  the  pro.qrram.  I  have  another  figure  for  the 
first  600  patients  who  were  admitted  on  an  ambulatory  basis.  The 
figures  are  roughly  similar. 

Mr.  Pertto.  The  first  1,000  patients,  I  take  it,  those  were  not  all 
ambulatory  patients  ? 

Dr.  Gearing.  None  of  them  were. 

Mr.  Perito.  How  long  were  the  addicts  confined  for  treatment  ? 

Dr.  Gearing.  Six  weeks. 

Mr.  Perito.  Then  released  and  come  back  on  a  periodic  basis  ? 

Dr.  Gearing.  No  ;  they  are  released,  then,  to  an  ambulatory  or  out- 
patient clinic  unit  where  they  come  in  initially  every  day  for  their 
medication  and  gradually  twice  a  week. 

Mr.  Perito.  Did  you  personally  secure  the  raw  data  or  was  it  pre- 
sented to  you  by  people  working  in  the  program  ? 

Dr.  Gearing.  No,  sir ;  the  majoritv  of  the  data  we  secure  ourselves. 
Our  prime  source  is  from  the  New  York  City  narcotics  register,  as  re- 
ported from  the  police. 

However,  the  data  that  we  get  from  the  program  would  tend  to  show 
that  it  is  very  useful,  too,  because  the  patients  do  report  to  the  program 
when  they  are  arrested  because  legal  counsel  is  available  to  them. 

Mr.  Perito.  Did  you  take  a  sampling  or  did  you  do  some  personal 
interviews  with  each  of  these  addicts  to  make  a  determination  as  to 
their  rate,  for  example,  of  illegal  activity  which  did  not  result  in  some 
type  of  criminal  charges  being  lodged  against  them  ? 

Dr.  Gearing.  No,  sir. 

Mr.  Perito.  Do  you  know  of  any  study  such  as  this  in  the  United 
States  where  the  addicts  were  interviewed  as  to  their  criminal  activity 
as  opposed  to  a  pure  evaluation  of  the  process  ? 

Dr.  Gearing.  No,  sir.  I  think  there  is  a  group  at  Harvard  that  may 
be  undertaking  such  a  study  in  a  patient  population  in  New  York. 

Our  charge  was  to  obtain  objective  criteria  for  evaluation,  and  we 
tried  to  make  it  as  obiective  as  possible  and  find  things  that  we  could 
measure,  and  the  things  we  could  measure  were  arrests  and  incar- 
cerations. 

Mr.  Perito.  And  your  study  of  the  New  York  program  is  ongoing ; 
is  that  correct? 

Dr.  Gearing.  Yes,  sir. 

Mr.  Perito.  I  understand  that  you  are  also  about  to  do  an  analysis 
and  efficacy  study  of  the  Narcotics  Treatment  Administration  in  Wash- 
ington ;  is  that  correct  ? 


107 

Dr.  Gearixg.  I  have  been  asked  to  consult  with  them  and  assist  them 
and  to  set  up  some  kind  of  ongoing  evahiation  for  their  program. 

Mr.  Perito.  Now,  going  back  to  your  New  York  program,  the 
statistics,  the  81.5  to  99  percent,  did  those  statistics  only  include  the 
1,000,  or  did  the  amount  of  patients  in  that  study  increase  ? 

Dr.  Gearixg.  No;  they  decreased  because  I  started  with  1,000 
patients,  the  first  1,000  patients  admitted.  Not  all  of  them  have  been 
in  the  program  for  4  years  because  of  the  way  the  patients  were 
admitted. 

Mr.  Perito.  What  was,  to  the  best  of  your  knowledge,  the  dropout 
rate  of  the  first  1,000  patients  ? 

Dr.  Gearixg.  The  dropout  rate  is  approximately  15  percent  during 
the  first  year,  about  5  percent  in  the  second  year,  and  about  2  percent 
a  year  for  the  ensuing  years. 

Mr.  Perito.  Did  your  analysis  also  include  an  evaluation  of  their 
return  to  work  or  to  school  ? 

Dr.  Gearix^g.  Yes,  sir. 

Mr.  Perito.  Could  you  tell  us  what  those  statistics  show  ? 

Dr.  Gearixg.  The  average  employment  percentage  for  patients  en- 
tering the  program  during  the  early  phases  was  approximately  25 
percent. 

Those  who  stayed  in  the  program  for  6  months,  approximately  45 
percent  of  them  were  employed. 

Those  who  stayed  in  the  program  over  a  year,  the  percentage  goes 
up  to  55,  and  for  those  who  have  been  in  the  program  5  years  or  longer, 
it  is  approximately  90  percent. 

Of  those  who  were  admitted  initially  on  an  ambulatory  basis  be- 
cause of  the  selective  process  by  which  they  tested  the  ambulatory 
procedure,  a  higher  percentage  of  them  were  employed  or  in  school 
at  the  time  of  admission. 

So  that  their  rate  of  increase  of  employment  is  not  as  great. 

However,  it  levels  off  to  approximately  the  same  figure  at  18  months. 

Mr.  Perito.  Dr.  Gearing,  did  you  ever  have  occasion  to  do  a  com- 
parative study  of  the  drug- free  approach  in  New  York  ? 

Dr.  Gearixg.  Did  I  ever  have  occasion  to  ? 

Mr.  Perito.  Yes. 

Dr.  Gearixg.  I  offered  my  services.  They  were  not  accepted. 

Mr.  Perito.  Do  you  know  of  any  studies  done  similar  to  the  studies 
which  you  did  on  the  methadone  programs  in  New  York  of  drug-free 
programs  anywhere  in  the  United  States  ? 

Dr.  Gearixg.  I  wish  I  did. 

Mr.  Perito.  To  the  best  of  your  knowledge,  those  studies  do  not 
exist  ? 

Dr.  Gearixg.  That  is  correct. 

Mr.  Perito.  Dr.  Gearing,  you  have  presented  us,  kindly,  with  a  paper 
which  you  presented  to  the  Third  National  Conference  on  Methadone 
Treatment  on  Saturday,  November  14, 1970  ? 

Dr.  Gearixg.  Yes,  sir. 

Mr.  Perito.  And  also  a  paper  which  you  gave  at  Pontiac,  Mich., 
on  December  2, 1970,  and  these  relate  to  your  studies  of  the  evaluation 
of  the  methadone  maintenance  approach ;  is  that  correct  ? 

Dr.  Gearix'g.  Correct, 

Mr.  Perito.  Are  these  the  two  latest  studies  which  you  have  done  ? 


108 

Dr.  Gearing.  Yes,  sir;  I  would  not  consider  the  position  paper  a 
study.  That  was  a  lawyer's  confrontation  for  which  I  wrote  a  position 
paper. 

Mr.  Perito.  Mr.  Chairman,  I  would  at  this  point  ask  that  these  two 
papers  be  incorporated  in  the  record. 

Chairman  Pepper.  Without  objection,  they  will  be  admitted  for  the 
record. 

(The  documents  referred  to  above  appear  at  the  end  of  Dr.  Gearing's 
testimony.) 

Chairman  Pepper.  Just  one  question  before  we  proceed. 

Is  it  your  conclusion,  therefore.  Dr.  Gearing,  from  the  studies  that 
you  have  made  over  a  period  of  time  that  methadone  is  the  best  treat- 
ment now  known  and  now  available  for  heroin  addiction? 

Dr.  Geartxg.  I  wouldn't  make  quite  that  strong  a  statement,  ISIr. 
Pepper.  I  would  say  that  for  those  patients  who  volunteered  for  the 
methadone  maintenance  treatment  program  who  have  a  history  of 
long-term  heroin  addiction,  this  is  the  best  treatment  we  have  at  the 
moment ;  yes. 

Chairman  Pepper.  And  you  did  find  a  striking  diminution  in  the 
amount  of  crime  committed  by  the  people  who  took  methadone  who 
previously  had  a  heroin  addiction  ? 

Dr.  Gearing.  Yes,  sir.  These  were  patients  who  by  definition,  to  get 
into  the  program,  have  had  to  be  known  as  "criminal  addicts."  They 
had  to  have  had  previous  infractions  of  the  law. 

Chairman  Pepper.  Have  you  had  long  enough  experience  with  these 
people  who  took  methadone  to  determine  Avhether  it  became  addictive 
with  them. 

Dr.  Gearing.  I  am  not  sure  the  patients  who  have  been  on  the  pro- 
gram a  long  time  consider  themselves  addicted.  They  consider  them- 
selves dependent,  and  happily  dependent  because  it  has  freed  them 
from  the  problems  they  had  when  they  were  chasing  heroin. 

Chairman  Pepper.  Did  you  find  the  people  who  took  methadone  over 
a  period  of  time  have  suffered  any  apparent  trouble  or  physical  injury  ? 

Dr.  Gearing.  As  far  as  we  can  determine,  from  serial  medication 
examinations,  and  the  patients  in  the  program  5  years  or  longer  have 
been  monitored  carefully,  there  seems  to  be  no  physical  or  physiologi- 
cal problems. 

Chairman  Pepper.  Yesterday,  we  had  some  distinguished  witnesses 
here  who  said  that  they  did  not  think  that  private  physicians  should  be 
authorized  to  prescribe  methadone. 

What  is  your  recommendation  on  that  ? 

Dr.  Gearing.  If  you  will  look  at  the  recommendations  that  the  ad- 
visory committee  and  I  put  together  at  the  end  of  that  last  rei)ort,  we 
make  the  same  recommendation,  that  it  is  not  for  use  of  the  ])hysician 
in  his  private  office,  because  methadone,  in  and  of  itself,  is  only  really 
a  brid.o-e  which  allows  the  patients  time  to  get  involved  in  their  own 
rehabilitation. 

The  big  need,  for  manv  of  them,  is  to  gain  extra  skills,  to  find  a  job, 
and  many  other  social  services. 

Chairman  Pepper.  Mr.  Blommer,  do  you  have  any  questions? 

Mr.  Blommer.  Yes. 


109 

Doctor,  on  page  3  of  the  paper  that  you  have  kindly  given  us,  you 
show  the  reasons  for  discharge  from  the  program  as  being  alcohol 
abuse  and  abuse  of  other  drugs.  Now,  these  figures  are  relatively 
small. 

What  standards  are  applied  to  the  people  in  the  program  that 
could  lead  to  their  being  discharged  ? 

Dr.  Gearing.  Every  effort  is  made  in  the  program  to  help  them 
with  their  problems.  It  is  continual  abuse,  and  inability  to  handle 
their  other  problems,  that  may  lead  to  discharge. 

But  there  are  supportive  services.  In  fact,  particularly  in  the  Har- 
lem area,  working  on  the  alcohol  problem  they  have  one  full-time 
person.  And  many  of  the  patients  do  very  well. 

Mr.  Blommer.  Doctor,  would  it  be  a  fair  statement  to  say  that 
merely  because  someone  is  abusing  the  program,  and  by  that  I  mean 
not  just  taking  methadone,  but  also  taking  alcohol,  taking  ampheta- 
mines, that  this  abuse  would  not  be  grounds  enough  to  drop  them  from 
your  program? 

Dr.  Gearing.  That  is  correct.  I  think  initially  they  were  dropped 
from  the  program  for  two  reasons : 

One  was  the  program  was  not  equipped  to  handle  these  problems; 
and  second,  there  was  such  a  long  list  of  patients  waiting  to  get  into 
the  program;  the  waiting  time  had  become  so  long  that  the  decision 
on  the  part  of  the  program  people  was,  "How  to  do  the  best  job  for 
the  greatest  number,"  and  if  some  patients  Averen't  making  it  then  it 
was  better  to  substitute  somebody  else.  I  think  that  was  the  philosophv 
as  I  understood  it, 

Mr.  Blommer.  In  any  case.  Doctor,  if  someone  has  a  job,  would  you 
say  they  Avould  most  likely  be  retained  in  the  program,  that  job  being 
an  indication  they  were  adjusting? 

Dr.  Gearing.  Someone  has  a  job,  even  though  he  may  be  abusing 
drugs  or  alcohol ;  definitely. 

Mr.  Blommer.  So  that  your  statistics  of  people  having  a  job  bene- 
fits your  program? 

Dr.  Gearing.  It  is  not  my  program,  sir. 

Mr.  Blommer.  Excuse  me.  The  program  that  you  evaluate.  The 
chart  seems  to  go  up,  showing  that  more  and  more  people  have  jobs, 
and  the  sampling  goes  down. 

Dr.  Gearing.  It  is  not  the  sampling.  Remember,  patients  are  being- 
admitted  all  the  time.  So  that  at  any  point  in  time  you  have  so  many 
patients  in  the  program  only  2  weeks  or  3  months.  For  instance,  when 
I  started  evaluating  the  program  there  were  66  patients  in  the  pro- 
gram. Forty-five  of  those  patients  are  still  in  the  program,  but  those 
are  the  only  ones  on  whom  I  can  say  I  have  a  5-year  followup,  because 
that  is  all  the  patients  who  had  been  admitted  at  that  time. 

Mr.  Blomer.  In  other  words,  there  are  fewer  and  fewer  patients 
that  meet  the  criteria ;  is  that  correct? 

Dr.  Gearing.  No ;  the  program  started  5  years  ago  with  66  patients. 
That  is  all  the  5-year  followup  patients  I  could  possiblv  have,  ever: 
right? 

Mr.  Blommer.  I  see. 

Dr.  Gearing.  Now,  in  the  4-year  followup  we  have  a  smaller  num- 
ber and  right  now,  if  I  were  doing  a  3-month  followup,  I  would  have 


110 

somethino:  in  the  nei<rhborhood  of  6,000  patients.  That  is  the  rate  at 
■which  admissions  are  being  taken  on  now. 
Mr.  Blommer.  Let  me  switch  topics.  Doctor. 

Is  anyone  in  the  Dole-Nyswander  program  receiving  methadone 
maintenance  but  no  therapeutic  services? 
Dr.  Gearing.  There  is  a  small  group  that  was  started  last  July. 
Mr.  Blommer.  Have  you  any  statistics  on  whether  they  are  able  to 
stay  out  of  trouble  and  keep  jobs? 

Dr.  Gearing.  I  have  a  very  short  followup  on  them. 
Mr.  Bi,0MMER.  Is  there  any  trend  emerging? 

Dr.  Gearing.  Yes;  the  dropout  rate  is  somewhat  higher.  Their  ar- 
rest record  is  about  the  same,  and  their  rate  of  obtaining  new  employ- 
ment is  slightly  lower. 

Mr.  Blommer.  The  same  as  the  ones  who  are  receiving  therapy  ? 

Dr.  Gearing.  That  is  on  the  first  100  patients. 

Mr.  Blommer.  Would  it  be  a  fair  statement  to  say  that  the  trend, 
then,  is  away  from  therapy  as  opposed  to  more  therapy  ? 

Dr.  Gearing.  No;  I  would  say  the  trend  is  an  attempt  to  select  out 
of  a  group  of  patients  who  need  the  additional  supportive  services  and 
concentrate  the  supportive  services  on  those  who  need  them  the  most, 
or  start  with  supportive  services  for  patients  who  seem  to  need  it  and 
gradually  put  them  into  a  less-structured  program. 

Mr.  Blommer.  I  have  no  further  questions,  Mr.  Chairman. 

Chairman  Pepper.  Mr.  Waldie  ? 

Mr.  Waldie.  No  questions. 

Chairman  Pepper.  Mr.  Wiggins  ? 

Mr.  Wiggins.  Yes,  Mr.  Chairman. 

Doctor,  what  is  the  proper  name  for  this  program  to  which  we  have 
referred  in  general  terms  ? 

Dr.  Gearing.  It  was  ori.qinollv  known  as  the  Dole-Nvswander  pro- 
gram ;  later  on  known  as  the  Beth  Israel  procrram ;  now  the  Methadone 
Treatment  Program  in  New  York  City  and  Westchester  County,  be- 
cause it  now  encompasses,  in  addition  to  those  units  I  have  mentioned, 
another  unit  in  the  Bronx  and  the  New  York  City  program  which 
started  the  first  of  November. 

Mr.  Wiggins.  Who  is  the  dire<"tor  of  the  program  ? 

Dr.  Gearing.  Dr.  Harvey  Gollance  would  be  the  director  of  those 
portions  that  come  under  what  is  now  called  the  Beth  Israel  program. 

Mr.  Wiggins.  How  do  you  spell  his  name  ? 

Dr.  Gearing.  G-o-l-l-a-n-c-e,  and  Dr.  Robert  Newman  is  the  direc- 
tor of  the  New  York  City  program  and  Dr.  Edward  Gordon  is  the 
director  of  the  Westchester  program. 

Mr.  Wiggins.  Is  this  a  private  program  or  a  Government  program  ? 

Dr.  Gearing.  Beg  pardon  ? 

Mr.  Wiggins.  Is  this  a  private  program  or  a  Government  program  ? 

Dr.  Gearing.  It  is  a  projrram,  with  one  small  minor  exception, 
supported  by  the  State  of  New  York  Narcotics  Addiction  Control 
Commission. 

Mr.  Wiggins.  So  far  as  you  know,  are  there  any  direct  Federal 
grants  involved  in  the  program  ? 

Dr.  Gearing.  As  far  as  I  know,  except  for  perhaps  some  laboratory 
research  at  Rockefeller  University,  there  is  no  Federal  money  in  this 
program. 


11(1 

Mr.  "VViGGixs.  How  does  a  patient  qualify  for  the  program,  Doctor? 

Dr.  Gearing.  Well,  that  is  a  little  bit  out  of  my  field,  but  a  patient 
applies  for  admission.  He  is  screened  and  he  has  to  meet  certain 
criteria. 

Mr.  Wiggins.  Would  it  be  accurate  to  say  that  all  of  the  patients 
are  voluntary? 

Dr.  Gearing.  Absolutely.  In  fact,  they  have  to  sign  a  voluntary 
commitment  to  take  the  medication. 

Mr.  Wiggins.  Is  there  a  method,  so  far  as  you  know,  of  course  in 
the  State  of  New  York,  whereby  courts  may  compel  attendance  to 
methadone  programs  as  a  condition  to  probation,  for  example? 

Dr.  Gearing.  Compel  ? 

Mr.  Wiggins.  Yes,  ma'am. 

Dr.  Gearing.  No;  I  think  they  can  give  the  patient  the  option  of 
taking  methadone  or  going  into  one  of  the  other  nonmedication  pro- 
grams. 

Mr.  Wiggins.  Have  you  had  any  experience  in  evaluating  other  pro- 
grams in  which  you  might  give  us  some  guidance  concerning  the 
wisdom  of  compulsory  methadone  programs. 

Dr.  Gearing.  No  ;  I  sort  of  shudder  at  the  thought  of  compulsory 
treatment  programs.  I  would  think  that  voluntary  treatment  programs 
in  prisons  might  be  useful. 

I  think  to  legislate  medication  goes  against  my  physician's  blood. 

Mr.  Wiggins.  Yes,  ma'am. 

You  describe  in  your  prepared  statement  certain  security  techniques 
that  are  employed  to  insure  that  your  patients  are  not  using  the  pro- 
gram to  satisfy  their  own  drug  needs.  How  is  this  information  au- 
thenticated ? 

More  specifically,  let  us  suppose  that  a  patient  qualified,  how  do  you 
know  that  he  is  not  also  continuing  to  feed  his  heroin  addiction  on  the 
street  ? 

Dr.  Gearing.  Well,  he  is  periodically  tested  with  urine  samples. 

Initially,  he  has  a  urine  sample  taken  every  time  he  comes  in.  While 
the  patients  are  being  built  up  to  their  tolerance  dose,  many  of  them 
do  shoot  heroin,  there  is  no  question  about  it. 

Mr.  Wiggins.  Will  a  urine  sample  detect  the  presence  of  heroin  ? 

Dr.  Gearing.  No  :  it  will  detect  the  breakdown  products,  morphine, 
and  also  since  we  in  New  York  still  cut  it  with  quinine,  it  also  detects 
quinine. 

Mr.  Wiggins.  In  that  event  you  can  still  tell  whether  a  patient  is 
continuing  to  feed  his  heroin  addiction  by  shooting  heroin  from  th" 
street  ? 

Dr.  Gearing.  Yes. 

Mr.  Wiggins.  How  about  the  other  drugs  ? 

Dr.  Gearing.  This  is  really  a  program-type  question.  I  happen  to 
know  something  about  it,  but  this  is  not  really  my  field. 

The  other  drugs,  amphetamines,  barbiturates,  methadone,  and  co- 
caine, can  be  detected  in  urine.  Marihuana  and  alcohol ;  no. 

Mr.  Wiggins.  Let's  suppose  a  patient  signs  up  for  and  qualifies  for 
a  program  in  New  York  City  and  he  also  tries  to  sign  up  and  qualify 
for  another  program  to  get  a  double  dosage.  How  is  that  prevented  2 

Dr.  Gearing.  We  are  attempting  to  prevent  this  in  that  we  have 
what  is  known  as  a  data  bank  where  each  patient  that  applies  for  a 


112 

program  is  put  into  the  machinery  and  matched  by  his  first  name, 
last  name,  and  his  mother's  maiden  name,  which  seems  to  be  more 
useful  than  the  birth  date,  to  prevent  this  kind  of  duplication. 
So  far,  I  think  two  have  been  picked  up. 

Mr.  Wiggins.  If  a  person  just  simply  used  a  different  name,  would 
he  be  detected  ? 

Dr.  Gearing.  No.  What  purpose  would  be  served  by  a  patient  going 
to  more  than  one  program  'i 

Mr.  Wiggins.  Well,  1  don't  know,  Doctor.  Maybe  you  can  help  me. 
Dr.  Gearing.  Because  he  takes  his  medication  daily.  He  takes  his 
medication  at  the  clinic.  He  is  giving  no  medication  to  take  home. 

Mr.  Wiggins.  I  understand  that.  Would  a  person  who  is  dependent 
upon  methadone  and  had  a  prior  history  of  heroin  addiction,  get  a 
greater  euphoric  effect,  or  whatever  the  impact  may  be,  from  a  second 
dose  of  methadone  than  he  would  from  just  one  ? 
Dr.  Gearing.  You  will  have  to  ask  the  patients.  I  don't  know. 
I  know  the  experience  with  the  majority  of  the  patients  who  have 
been  in  the  program  for  some  months,  many  of  them  ask  to  have  their 
dosages  cut  down.  They  do  not  develop  a  tolerance  like  with  heroin 
where  they  have  to  get  increasing  dosage.  At  the  stabilizing  dose,  some- 
where between  80  and  120  milligrams  a  day,  they  don't  appear  to  crave 
more. 

Mr.  Wiggins.  Is  that  conclusion  generally  held  in  the  medical  com- 
munity ;  namely,  that  a  stabilizing  tolerance  is  achieved  with  metha- 
done programs,  unlike  other  analgesic  substances  ? 

Dr.  Gearing.  I  don't  think  there  is  anything  about  the  drug  addiction 
field  that  is  universally  held  in  the  medical  profession. 

Mr.  Wiggins.  Do  you  have  any  comment  about  that?  Have  your  col- 
leagues, so  far  as  you  know,  come  to  a  contrary  conclusion? 
Dr.  Gearing.  None  who  work  for  the  program;  no. 
Mr.  Wiggins.  Doctor,  I  gather  that  there  is  some  diversion  in 
methadone  and  that  it  can  be  obtained  occasionally  on  the  street.  What 
do  you  believe  is  the  source  of  that  diversion? 

Dr.  Gearing.  In  New  York  City  the  source  of  that  diversion  is  al- 
most exclusively  the  private-practice  physician  who,  in  being  kind  to 
his  patient,  gives  him  not  one  dose  but  several  doses,  such  as  a  pre- 
scription for  several  doses  or  a  week's  supply. 

Mr.  Wiggins.  Do  you  have  any  recommendations  to  this  committee 
on  how  that  problem  might  be  curtailed  ? 

Dr.  Gearing.  I  think  my  recommendation  is  that  I  wish  that  physi- 
cians were  not  giving  it  in  their  private  offices,  but  apparently  that  is 
being  done. 

Mr.  Wiggins.  Will  it  be  your  recommendation  that  the  private  dis- 
pensing of  methadone  outside  of  a  control  clinic  be  banned  entirely  ? 

Dr.  Gearing.  No;  the  recommendation  is  that  those  physicians  wlio 
are  interested  in  working  with  drug  addicts  in  methadone  maintenance 
affiliate  themselves  wnth  some  kind  of  an  ongoing  progi-am  and  that  as 
the  patients  become  stabilized  and  no  longer  need  the  supportive  serv- 
ices of  a  total  program  that  the  private  sector  could  then  take  on  the 
patient. 

Mr.  Wiggins.  Doctor,  so  far  the  witnesses  agree  that  methadone  is  a 
dangerous  addicting  narcotic,  and  1  am  sure  you  agice  with  that 
statement. 

Dr.  Gearing.  Yes. 


113 

Mr.  WiGGixs.  Is  it  more  difficult  to  withdraAv  a  patient  addicted  to 
methadone  than  it  is  a  patient  addicted  to  heroin  ? 

Dr.  Gearing.  No;  I  think  it  takes  a  little  bit  longer,  because  the 
methadone  that  they  are  getting  when  they  are  on  methadone  mainte- 
nance is  pr-etty  good  stuff.  The  heroin  that  they  are  getting  on  the  street 
is  not  such  good  stuff. 

Mr.  Wiggins.  I  am  going  to  use  a  term  that  may  not  be  appropriate. 
I  am  going  to  use  the  term  "euphoria."  That  may  not  be  truly  descrip- 
tive of  the  effect  on  the  human  body,  but  you  use  the  appropriate  tenn. 

What  is  the  difference  in  the  euphoric  effect  between  the  use  of  heroin 
and  the  use  of  methadone  ? 

Dr.  Gearing.  The  difference  is  primarily  in  the  mode  in  which  it  is 
given.  If  methadone  is  injected  euphoria  is  obtained.  Methadone  given 
by  mouth,  the  euphoria,  as  I  understand,  it  does  not  occur. 

Heroin  given  by  mouth  doesn't  do  anything. 

Mr.  Wiggins.  Methadone  is  an  antagonistic  drug;  isn't  it? 

Dr.  Gearing.  No  ;  it  is  known  as  a  block. 

Mr.  Wiggins.  Yes ;  but  it  is  not  antagonistic. 

TVhat  satisfies  the  psychic  craving  for  the  euphoric  effect  if  they 
don't  get  it  on  the  methodone  maintenance  program  ? 

Dr.  Gearing.  My  judgment  Avould  be  that  the  heroin  addict  has  two 
phases.  He  has  a  euphoric  phase.  He  also  has  a  fear  of  withdrawal 
phase.  I  think  that  this  stabilization  seems  to  block  that  craving.  I  can't 
answer  that  any  further  because  I  don't  know. 

Mr.  AViGGiNS.  Have  you  observed  that  there  is  abuse  by  shooting 
methadone  on  the  streets  of  New  York,  for  example  ? 

Dr.  Gearing.  Very  little. 

Mr.  Wiggins.  Is  it  more  dangerous  if  applied  intravenously? 

Dr.  Gearing.  The  methadone  that  is  used  in  the  methadone  main- 
tenance program  is  theoretically  noninjective. 

Mr.  Wiggins.  That  i=i  all  I  have,  Mr.  Chairman. 

Chairman  Pepper.  Mr.  Waldie  ? 

Mr.  Waldie.  No  questions. 

Chairman  Pepper.  Mr.  Brasco  ? 

Mr.  Brasco.  Yes. 

Dr.  Gearing,  I  understood  you  to  say  before — correct  me  if  I  am 
wrong — that  the  methadone  detoxification  program  as  measured  in 
relationship  to  criminality  was  not  as  successful 

Dr.  Gearing.  I  didn't  talk  about  the  methadone  detoxification  pro- 
gram. I  talked  to  about  100  patients  that  we  selected  out  of  the  detoxifi- 
cation program  by  virtue  of  the  fact  that  they  matched  by  age  and  by 
ethnic  group  and  time  of  admission  to  detoxification  unit  the  patients 
in  the  methadone  maintenance  program,  and  we  followed  this. 

Mr.  Brasco.  May  I  ask  you  this.  Doctor?  In  connection  with  the 
methadone  maintenance  program ;  is  there  anything  within  the  con- 
fines of  the  program  itself  that  leads  toward  the  eventual  withdrawal 
of  all  drugs  ? 

Dr.  Gearing.  There  is  no  plan  in  the  program  for  a  time  when  a 
patient  shall  be  withdrawn  from  methadone ;  is  that  what  you  mean  ? 

Mr.  Brasco.  Yes. 

Dr.  Gearing.  Many  of  the  patients  ask  to  be  withdrawn  with  the 
notion  that  they  think  they  can  make  it  on  their  own,  and  they  are 
withdrawn  and  then  they  are  given  the  privilege  of  returning.  I  think 


114 

you  have  some  data  there  that  shows  that  a  goodly  portion  of  them  do 
return. 

Mr.  Brasco.  They  do  return  ? 

Dr.  Gearing.  Although  a  small  proportion  of  them  go  into  absti- 
nence programs. 

Mr.  Brasco.  In  connection  with  dispensing  of  methadone,  I  under- 
stood you  to  say  that  initially  the  patients  took  their  dosage  at  the  insti- 
tution where  they  entered  the  program  and  later  on  they  come  twice  a 
week. 

Dr.  Gearing.  Some  of  them  come  twice  a  week.  Some  of  them  never 
get  beyond  the  every  day.  This  depends  upon  a  good  many  things,  in- 
cluding their  own  rehabilitation. 

Mr.  Brasco.  I  take  it  those  who  come  twice  a  week 

Dr.  Gearing.  Yes ;  in  a  locked  box. 

Mr.  Brasco.  No  ;  I  wasn't  trying  to  be — I  personally  agree  with  your 
first  statement.  Maybe  I  should  have  said  that  first,  that  this  is  proba- 
bly the  best  we  have  to  offer. 

Dr.  Gearing.  At  the  present  time. 

Mr.  Brasco.  What  1  was  trying  to  do  was  to  get  some  answers  from 
you.  The  program  has  been  from  time  to  time,  as  you  know,  criticized. 
One  of  the  things  is  the  incidence  of  death.  I  heard  some  statistics — I 
am  not  saying  it  is  true,  I  am  just  saying 

Dr.  Gearing.  That  is  from  what,  bv  whom  ? 

Mr.  Brasco.  Where  did  we  get  the  statistic,  Paul,  with  respect  to 
the  deaths  ? 

Mr.  Steiger.  In  children. 

Dr.  Gearing.  Death  in  children,  three. 

Mr.  Steiger.  Six. 

Dr.  Gearing.  Is  it  six  now  ?  In  New  York  City  ? 

Mr.  Steiger.  Here,  in  Washington,  D.C. 

Mr.  Brasco.  In  any  event,  is  there  any  reason  why  we  couldn't  have 
all  of  the  people  in  the  program  report  every  day  for  their  dose? 

Dr.  Gearing.  It  impairs  the  rehabilitation  of  the  patient.  In  trying 
to  be  fair  to  a  patient  you  would  like  to  give  him  some  freedom  as  he 
stabilizes  and  becomes  a  productive  citizen. 

Therefore,  this  is  actually  the  one  punitive  measure  that  is  used  in 
a  program,  and  that  is  if  a  patient  begins  getting  into  trouble  or  act- 
ing up  or  abusing  other  drugs  they  are  put  back  to  having  to  come  in 
every  day. 

At  the  moment,  they  are  all  given  weekend  medication  to  take 

home. 

Mr.  Brasco.  Just  one  last  question  in  connection  with  Mr.  Wiggins 
line  of  questioning  concerning  the  fact  that  some  of  the  methadone 
was  getting  into  the  streets  of  New  York.  That  must  be  measured  with 
the  severe  limitations  that  there  are  in  connection  with  the  program. 

I  had  a  young  man  come  to  my  office  several  weeks  ago,  and  it  took 
me  a  day  and  a  half,  calling  all  oVer  the  place,  trying  to  find  a  spot 
for  him.  , 

In  any  event,  I  kind  of  suspect  that  if  the  program  was  developed 
i  n  large  cities  in  the  way  that  you  described 

Dr.  Gearing.  The  program  is  expanding  astronomically. 

Mr.  Brasco  (continuing).  There  would  never  been  any  need  tor  it 
being  dispensed  by  anyone  else. 


115 

Dr.  Gearing.  The  New  York  City  program,  which  started  on  No- 
vember 1,  was  wondering  where  they  were  going  to  get  their  patients. 
They  now  have  a  waiting  list  of  over  1,000  patients.  They  have  3,000 
who  may  be  accepted,  and  money  for  2,000,  and  the  other  1,000  will 
be  waiting. 

Mr.  Brasco.  The  question  really  is :  In  New  York  there  are  mone- 
tary limitations? 

Dr.  Gearing.  It  is  monetary  limitations  and  staffing. 

Mr.  Brasco.  And  staffing  ? 

Dr.  Gearing.  Yes;  and  also  finding  locations  which  will  accept  a 
narcotic  treatment  program  in  the  area.  Not  every  area  of  New  York 
City,  as  you  may  know,  enjoys  the  idea  of  having  a  methadone  main- 
tenance treatment  program  on  their  block. 

Mr.  Brasco.  Unfortunately,  I  do  know  something  about  that. 

Might  we  integrate  that  with  a  hospital  service?  Might  that  help 
cut  down  on  that  problem  ?  In  other  words,  use  a  portion  of  a  hospital  ? 

Dr.  Gearing.  This  has  been  done  at  Delafield  and  the  Washington 
Heights  Center.  There  are  two  units  in  the  Washington  Heights 
Health  Center  and  one  in  the  Delafield  Hospital. 

Mr.  Brasco.  Thank  you. 

Chairman  Pepper.  Mr.  Steiger. 

Mr.  Steiger.  Thank  you.  I  was  very  interested,  Doctor,  in  Mr.  Wig- 
gins' approach  on  the  possibility  of  the  patient  continuing  his  heroin 
habit  undetected.  The  urine  analysis  is  the  only  method  that  this 
program  uses  to  detect  the  heroin  ? 

Dr.  Gearing.  It  is  the  only  method  there  is,  as  far  as  I  know,  and 
it  only  detects  heroin  taken  within  the  last  24  hours. 

Mr.  Steiger.  I  assume  they  use  interviews  also;  I  mean,  they  ask 
them? 

Dr.  Gearing.  The  patients  squeal  on  each  other. 

Mr.  Steiger.  ^Yhat  is  the  incentive  to  squeal  ? 

Dr.  Gearing.  Pride  in  the  program. 

Mr.  Steiger.  Is  there  any  method  you  know  of,  of  beating  the  test, 
beating  the  urine  analysis  ? 

Dr.  Gearing.  Oh,  I  am  sure  there  is.  The  urine  analysis  is  not  used 
in  the  punitive  sense.  It  is  used  primarily  for  counseling.  They  don't 
shake  their  finger  and  say  "You  have  been  a  bad  boy." 

Mr.  Steiger.  An  addict  who  was  continuing  a  heroin  habit  and  had 
the  desire,  he  could  conceivabl}^  continue  it  and  stay  in  the  program 
undetected  ? 

Dr.  Gearing.  I  wouldn't  say  undetected;  no.  There  have  been,  I 
think,  something  like  1  percent  of  the  patients  who  have  been  dropped 
from  the  program  for  continual  shooting  of  heroin  after  they  were 
reaching — supposedly — a  stabilizinsr  dose.  The  theory  here  is  that  in 
these  patients  this  treatment  doesn't  work,  obviously. 

Mr.  Steiger.  The  ingenuity  of  the  addict  is  fairly  well  known.  He 
will  do  a  great  many  things  to  achieve — to  acquire —  the  drug  and 
use  it.  It  occurs  to  me  that  maybe  we,  as  an  interested  coneressional 
committee,  might  want  to  explore  possibly  a  more  efficacious  test. 
This  would  be  my  only  concern,  because  we  have  had  reports  of  urine 
analysis,  the  methods  of  beating  urine  analysis  itself,  some  very  in- 
genious methods.  It  occurs  to  me  it  might  be  worth  while  to  explore  a 
better  test. 


116 

Dr.  Gearing.  It  depends  on  what  you  are  concentrating  on.  Are  you 
concerned  about  the  urine  or  the  patient  ?  I  really  don't  know  what 
difference  the  urine  makes  if  he  has  become  a  productive  citizen  and 
is  able  to  function  and  is  staying  out  of  jail,  because  I  suspect  that  in 
certain  groups  of  the  population,  we  could  test  for  a  variety  of  drugs 
and  find  habitual  users,  even  among  such  illustrious  people  as  among 
our  Congress. 

Mr.  Wiggins.  Users  of  what  ? 

Dr.  Gearing.  Drugs,  amphetamines,  barbiturates,  tranquilizers,  pep- 
up  pills,  et  cetera. 

Mr.  Wiggins.  I  just  didn't  want  you  to  be  misunderstood  as  accusing 
Members  of  Congress  shooting  heroin. 

Dr.  Gearing.  No.  I  think  in  a  rehabilitation  program  of  this  kind 
one  can  get  overly  hung  up  on  urine  testing,  which  is  a  very  expen- 
sive and  time-consuming  part  of  the  operation.  I  think  it  is  very  good 
from  a  counseling  standpoint  to  let  the  patient  know  that  big  brother 
is  watching  him,  but  as  far  as  handling  the  patient  and  his  problem, 
it  is  not  his  urine  you  are  concerned  about. 

Mr.  Steiger.  The  whole  problem,  it  seems  to  me,  the  basic  objec- 
tion to  the  problem  in  terms  of  laymen  is  we  are  substituting  one 
dependence  for  another,  and  in  this  instance  we  may  not  even  be  doing 
that.  We  may  simply  be  mitigating  the  original  dependence. 

I  would  like  to  ask  one  question :  On  urine  analysis,  have  you  been 
able  to  get  a  statistically  representative  group  of  people  who  have  been 
through  the  program  for  a  given  period,  whatever  that  may  be,  and 
now  no  longer  take  methadone  and  are  no  longer  addictive  and  are 
productive  ?  Are' there  any  fisrures  like  that  ? 

Dr.  Gearing.  We  are  in  the  process  of  trying  to  find  those  people. 
They  can  find  those  who  haven't  made  it.  That  is  the  easiest  thing, 
because  we  can  find  them  through  our  other  reporter  services. 

We  have  a  group  of  some  20  percent  of  the  patients  who  have  left 
the  program  that  we  haven't  been  able  to  find  through  these  sources. 
We  are  now  in  the  process  of  trying  to  find  out  what  proportion  of 
these  people  are,  in  fact,  drug  free. 

Mr.  Steiger.  My  question  is:  In  your  opinion  is  it  possible  for 
somebody,  through  the  methadone  maintenance  program,  to  achieve 
independence  from  methadone  and  anything  else,  or  do  we  have  to  an- 
ticipate that  he  will  be  a  methadone  addict  for  the  rest  of  his  life '? 

Dr.  Gearing.  From  the  information  I  have  at  the  present  time  I 
would  equate  methadone  maintenance  with  insulin  for  diabetics,  as 
probably  a  lifelong  commitment  for  many  of  the  patients. 

Chairman  Pepper.  Mr.  Mann. 

Mr.  Mann.  Doctor,  in  your  evaluation,  what  employment  problems 
or  patterns  do  you  find  these  people  having  and  is  the  community  prej- 
udiced or  reluctant  to  employ  these  neonle  ? 

Dr.  Gearing.  The  answer  to  the  last  question  is  yes.  in  some  areas. 
The  experience  that  has  come  about  in  the  pro.Qfram  is  that  it  is  like 
getting  the  first  olive  out  of  the  bottle.  Gettin.q;  the  first  man  on  meth- 
adone maintenance  employed  in  a  particular  industry  or  jxroiin  is  the 
tough  one.  Once  they  have  accepted  the  first  one  and  thev  find  out 
that  he  is  a  useful  citizen,  then  getting  other  people  into  that  is  a 
simnler  iob.  That  is  one  point. 

The  main  point,  I  think,  is  that  many  of  them  have  to  be  given 


117 

some  kind  of  skill  training  in  order  to  be  employable  above  the  wel- 
fare level,  and  this  has  taken  some  doing  and  is  an  active  part  of 
the  program. 

Does  that  answer  your  question  ? 

Mr.  Mann.  Yes ;  thank  you. 

Can  a  person  be  on  methadone  and  take  a  periodic  heroin  shot 
for  the  euphoric  effect  and  incur  no  increased  physical  danger  be- 
cause of  the  combination  of  the  two  ? 

Dr.  Gearing.  I  can't  answer  the  question  on  physical  danger.  The 
answer  from  the  standpoint  of  the  patient  is  that  many  of  them  in 
the  first  few  months  that  they  are  on  methadone  maintenance  do 
shoot  heroin  and  come  back  very  angry  because  they  spent  their  money 
on  nothing,  because  they  get  no  euphoria.  That  is  supposedly  the  block 
of  methadone,  is  that  it  blocks  the  effects  of  heroin. 

Chairman  Pepper.  We  will  take  a  short  recess  at  this  point. 

(A  brief  recess  was  taken.) 

Chairman  Pepper.  The  meeting  will  come  to  order,  please. 

Dr.  Gearing,  if  I  may  interrupt  before  the  other  members  return, 
I  Avould  iust  like  to  ask  you  three  things : 

One :  We  have  had  reports  that  about  six  people  have  died  fn  the 
District  of  Columbia  in  the  last  few  months  from  taking  methadone. 
Have  you  any  comment  to  make  on  that  ? 

Dr.  Gearing.  I  would  defer  that  to  Dr.  DuPont  in  his  testimony, 
because  he  has  the  knowledge.  I  have  only  read  it  in  the  newspapers. 

Chairman  Pepper.  Have  you  experienced  deals  from  methadone  in 
New  York? 

Dr.  Gearing.  Yes. 

Chairman  Pepper.  Roughly  how  many  ?  ^ 

Dr.  Gearing.  Aside  from  the  ones  in  children,  which  were  acci- 
dentally taken  thinking  it  was  orange  juice,  I  think  that  there  may  be 
two  or  three  in  the  young  teenagers. 

Chairman  Pepper.  In  your  experience,  are  the  deaths  generally  in 
cases  where  they  were  not  previously  addicted  to  heroin  and  they  just 
started  right  off  taking  methadone  ? 

Dr.  Gearing.  They  were  not  tolerant  to  the  dose  of  methadone  they 
were  taking.  Whether  they  were  on  other  drugs  or  not,  I  don't  know. 

Chairman  Pepper.  Does  the  taking  of  heroin  give  you  a  tolerance  for 
methadone  ? 

Dr.  Gearing.  I  don't  know. 

Chairman  Pepper.  Well,  the  deaths,  you  would  say,  are  people  who 
have  not  developed  tolerance  for  methadone  ? 

Dr.  Gearing.  That  is  correct. 

Chairman  Pepper.  Who  are  beginning  to  take  it  for  the  first  time  ? 

Dr.  Gearing.  Who  just  took  it  accidentally  or  just  for  kicks,  just  like 
many  of  the  heroin  deaths  we  have  in  New  York  City  are  not  in 
addicted  kids.  They  are. in  kids  that  are  shooting  for  the  first  or  second 
time  and  get  either  an  allergic  or  some  other  kind  of  reaction,  or  a  real 
overdose. 

Chairman  Pepper.  Do  you  agree  with  the  testimony  before  this 
committee  of  Dr.  Halpern  of  the  city  of  New  York,  that  any  given 
dose  of  heroin,  even  to  an  addict,  may  be  a  fatal  one  ? 

Dr.  Gearing.  I  certainly  wouldn't  contradict  Dr.  Halpern  in  a  field 
in  which  he  is  an  expert  and  I  am  not. 


118 

Chairman  Pepper.  Would  you  have  any  comment  to  make  about  the 
District  of  Columbia  methadone  maintenance  program  ? 

Dr.  Gearing.  Very  few  comments  at  the  present  time,  because  I 
have  just  recently  started  working  with  them.  I  think  my  first  com- 
ment is  on  how  rapidly  it  has  ^rown  and  how  well  they  were  handling 
the  problem  of  large  numbers  in  any  single  unit. 

On  my  first  visit  to  D.C.  Hospital  I  was  overwhelmed  with  the  size 
of  their  population,  that  they  were  handling  with  the  staff  that  they 
had  and  their  unit  at  that  point  was,  I  think,  something  in  he  neighbor- 
hood of  600  patients.  In  T^ew  York  City,  most  of  the  outpatient  units 
handle  between  125  and  150  patients  each. 

Chairman  Pepper.  Do  you  have  enough  money  and  personnel  and 
facilities  for  the  treatment  of  all  of  the  heroin  addicts  in  the  city  of 
New  York? 

Dr.  Gearing.  Do  I,  sir  ? 

Chairman  Pepper.  Yes.  Are  there  available  enough  facilities  and 
personnel  ? 

Dr.  Gearing.  I  am  sure  the  answer  to  that  is  an  unqualified  no.  I 
don't  know  if  there  is  enough  money  in  the  world. 

Chairman  Pepper.  Same  situation  all  over  the  country  ? 

Dr.  Gearing.  Yes. 

Chairman  Pepper.  One  other  thing.  Would  you  state  what  are  the 
goals  of  the  methadone  maintenance  program  ? 

Dr.  Gearing.  Freedom  from  "heroin  hunger,"  decrease  in  antisocial 
behavior,  increase  in  social  productivity,  and  recognition  and  willing- 
ness to  accept  help  for  other  problems,  such  as  alcohol  abuse,  other 
drugs,  psychiatric  and  medical  problems. 

Chairman  Pepper.  Mr.  Winn. 

Mr.  Winn.  Thank  you,  Mr.  Chairman. 

Dr.  Gearing,  just  a  quick  question.  We  heard  yesterday  in  the  testi- 
mony the  difference  between  psychotic  craving  and  physiological  crav- 
ing. What  is  the  methadone  reaction  to  these  two  cravings  ? 

Dr.  Gearing.  The  two  psychiatrists  who  will  follow  me  will  probably 
be  able  to  answer  that  question  much  better  than  I. 

It  would  appear  from  the  patients  who  are  admitted  to  the  metha- 
done maintenance  program  in  New  York  City  that  gross  psychiatric 
problems  are  not  a  major  portion  of  their  problems.  They  have  be- 
havioral problems  very  similar  to  the  behavior  problems  that  some  of 
the  rest  of  us  have,  and  need  sometimes  more  help  with  those  and 
psychiatric  help  is  available  both  on  an  individual  basis  and  group 
psychotherapy. 

But  it  is  not  universally  required. 

Mr.  Winn.  The  testimony  yesterday  was  that  they  could  go  through 
all  of  these  treatments,  cold  turkey  and  all  of  that,  and  still  have  a 
psychiatric  craving,  that  even  though  they  were  supposedly  cured,  the 
psychiatric  craving  would  drive  them  back  to  hef  oin. 

Dr.  Gearing.  I  am  sorry,  but  I  don't  know  what  a  psychiatric  crav- 
ing is,  so  I  can't  answer  your  question. 

Mr.  Winn.  But  you  have  heard  the  term  ? 

Dr.  Gearing.  Yes. 

Mr.  Winn.  Thank  you  very  much. 

Chairman  Pepper.  Sorry,  Mr.  Mann,  had  you  finished  your  ques- 
tioning? 


119 

Mr.  Manx.  I  have  one  or  two  more,  and  I  think  perhaps  I  am  in  the 
psychiatric  field,  too,  but  not  in  the  evaluation  field. 

Would  a  nonaddict  enjoy  the  methadone  program  ? 

Dr.  Gearing.  Would  a  nonaddict  ?  I  wouldn't  think  so. 

Mr.  Mann.  Well,  it  offers  a  lot  of  other  benefits,  other  than  mere 

Dr.  Gearing.  Not  really;  you  have  to  take  an  awful  lot  of  medica- 
tion every  day. 

Mr.  Mann.  Could  a  nonaddict  get  into  the  program  ? 

Dr.  Gearing.  It  would  be  difficult. 

Mr.  Mann.  This  again  is  a  question  I  perhaps  shouldn't  ask. 

Does  the  existence  of  a  methadone  program  perhaps  lessen  the  stigma 
or  lessen  the  resistance  to  one  becoming  involved  in  heroin  in  the 
first  place  ? 

Dr.  Gearing.  I  have  no  idea  but  I  would  think  not ;  no. 

Mr.  Mann.  You  would  hope  not  ? 

Dr.  Gearing.  Yes. 

Mr.  Mann.  You  obviously  have  great  faith  in  this  program,  and  I 
am  curious  as  to  your  major  reaction,  based  on  your  evaluation  as  to  the 
disadvantages,  not  in  detail,  but  your  major  reaction  to  the  disad- 
vantages. 

Dr.  Gearing.  The  disadvantages  have  been  well  stated  by  many 
people.  The  first  one  is  that  it  is  an  addictive  drug  that  you  are  sub- 
stituting for  another  one.  This  is  not  my  major  objection. 

The  second  is  it  is  a  drug  that  has  to  be  taken  every  day.  It  is  our 
hope  that  at  some  point  there  will  be  developed  a  longer  acting  metha- 
done kind  of  treatment. 

I  think  the  major  objection  to  the  program  in  New  York  City  is 
the  waiting  time  it  takes  to  get  into  it,  once  the  patient  makes  the  de- 
cision that  he  wants  to  try  it. 

Mr.  Mann.  Thank  you. 

Thank  you,  Mr.  Chairman. 

Chairman  Pepper.  Mr.  Keating? 

Mr.  Keating.  No  questions. 

Chairman  Pepper.  Mr.  Rangel  ? 

Mr.  Rangel.  Yes ;  Mr.  Chairman. 

Doctor,  a  lot  of  support  is  received  by  the  methadone  proponents 
because  of  the  drastic  decrease  in  crime.  You  presented,  this  morning, 
some  rather  dramatic  statistics,  and  if  I  understand  them  correctly, 
you  took  a  sampling  of  drug  addicts  and  compared  their  records  after 
having  gone  through  the  methadone  treatment. 

Dr.  Gearing.  Yes;  using  the  same  sources  of  information  we  use 
on  patients  in  the  program. 

Mr.  Rangel.  And  using  their  past  criminal  records  as  an  indication 
of  how  drastic  the  criminal  activities  were  reduced. 

Now,  as  a  part  of  your  program,  I  understand  that  you  offer  medical- 
psychiatric-social  services,  educational,  job  training,  and  all  of  this  as 
a  part  of  the  methadone  training  program  or  methadone  treatment 
program ;  is  that  correct  ? 

Dr.  Gearing.  Those  services  are  all  available  to  the  patient ;  yes,  sir. 

Mr.  Rangel.  Assuming  that  all  crimes  are  not  comitted  by  addicts, 
that  you  had  a  group  of  people  in  central  Harlem  that  have  the  same 
type  of  criminal  record,  and  they  were  offered  the  same  type  of  sup- 
portive services,  of  course,  without  the  assistance  of  methadone,  would 


120 

it  not  be  so  that  we  could  project  a  drastic  decrease  in  their  criminal 
activity,  especially  in  view  of  the  fact  that  many  of  these  addicts  are 
former  addicts  employed  by  the  programs  on  which  they  are  treated? 

Dr.  Gearing.  I  would  hope  that  that  were  true,  and  I  would  like 
some  data  to  show  that  it  is  true.  The  problem  that  we  have  had,  is  we 
have  no  comparative  data,  that  is  the  reason  we  have  to  force  a  com- 
parison group.  We  have  no  data  from  any  group  that  has  such  a 
facility. 

The  only  data  we  do  have  is  in  the  detoxification  unit.  They  do 
have  a  group  where  they  have  offered  the  services  and  they  have  not 
been  terribly  successful. 

Mr.  Rangel.  Notwithstanding  all  of  this  dramatic  data  and  de- 
crease in  crime,  you  could  not  really  determine  whether  or  not  the 
decrease  was  due  to  job  training,  consultant  services,  opportunities 
for  employment,  or  methadone? 

Dr.  Gearing.  That  is  correct.  What  we  are  saying  is  that  this  pro- 
gram offering  this  package  in  this  way  is  doing  this.  That  is  all  we 
can  say. 

Mr.  Rangel.  Right. 

Now,  in  answer  to  a  previous  question  you  were  saying  that  it  is  pos- 
sible for  one  to  get  a  high,  say,  from  methadone  if  not  given  orally. 

Dr.  Gearing.  It  is  my  understanding  that  methadone  intravenously 
gives  a  very  nice  high. 

Mr.  Rangel.  Well,  the  drug  which  is  presently  being  adminis- 
tered in  New  York,  could  that  be  reduced  to  liquid  so  that  it  could  be 
given  intravenously  ? 

Dr.  Gearing.  As  I  understand  it,  it  is  very  difficult.  I  was  goin^  to 
say  it  can't  be  done,  but  I  was  told  today  that  it  can,  and  knowing 
addicts  who  can  shoot  milk  and  a  few  things  that  some  of  the  rest  of 
us  wouldn't  dream  of,  they  probably  could  shoot  it ;  yes. 

Mr.  Rangel.  Well,  being  raised  in  that  community  and  still  li\dng 
there,  there  is  some  thought  we  have  now  developed  a  type  of  metha- 
done addict,  and  my  real  question  was  in  view  of  the  earlier  question 
of  dual  registration  or  using  different  names,  if  you  now  believe,  as  I 
believe,  that  it  is  possible  to  be  produced  as  to  what  is  dispensed  to  a 
drug  that  can  be  injected  into  the  body  intravenously,  then  what  is  to 
prevent  a  community  from  becoming  addicted  to  methadone  as  a  first 
experience  in  view  of  the  fact  that  the  patient  could  give  any  name 
and  give  a  different  name  and  receive  free  drugs? 

Dr.  Gearing.  I  think  this  goes  back  to  my  suggestion  that  the  dis- 
pensing of  the  drug  is  the  key  issue  in  this  whole  problem. 

Mr.  Rangel.  My  question  was  one  of  registration.  As  I  understood 
earlier 

Dr.  Gearing.  The  patients  do  not  get  a  week's  supply  of  medication 
to  sell  on  the  street.  The  patient  gets  one  dose  that  he  takes  on  the 
premises. 

Mr.  Rangel.  What  about  the  patients  that  you  were  saying  come 
in  twice  a  week? 

Dr.  Gearing.  Well,  those  patients  are  not  the  source  of  the  drugs 
on  the  street.  Those  are  the  patients  who  have  been  in  the  program  for 
a  good  long  time.  They  are  not  selling  it. 

Mr.  Rangel.  What  I  am  asking  is :  Is  it  possible  for  this  patient  to 


121 

go  to  two  or  three  different  clinics  and  use  two  or  three  different  names 
and  receive  two  or  three  weekly  dosages  ? 

Dr.  Gearing.  If  he  went  to  a  different  place  he  would  have  to  start 
all  over  again,  because  he  would  have  to  register  as  a  new  patient. 

Mr.  Brasco.  Would  you  yield  for  one  moment? 

Mr.  Rangel.  Yes. 

Mr.  Brasco.  Dr.  Gearing,  I  have  heard,  as  Congressman  Rangel  has 
been  trying  to  point  out,  that  there  is  some  traffic  in  the  street  with 
methadone,  but  what  would  be  the  value  ?  This  is  something  that  es- 
capes me.  Why  take  the  methadone  if  you  don't  get  the  euphoric  effect 
that  you  want  ?  Is  there  some  other  valiie  ? 

Dr.  Gearing.  These  are  questions  that  I  cannot  answer.  This  is  not 
my  field.  I  know  that  there  is  methadone  on  the  street,  and  I  think  I 
told  you  where  we  believe  the  major  source  of  it  comes  from.  In  fact,  it 
was  highlighted  in  the  Xew  York  Times  the  other  day.  I  do  not  think 
that  the  majority  of  methadone  on  the  street  comes  from  the  patients 
who  are  on  methadone  maintenance.  This  is  a  very  valuable  piece  of 
equipment  to  the  patients. 

Mr.  Brasco.  But  you  don't  know,  then,  I  take  it,  the  answer  to  my 
question.  "Whether  or  not  the  use  of  methadone  is  the  initial  attraction 
as  the  use  of  heroin  would  be  to  an  individual  ? 

Dr.  Gearing.  I  wish  you  would  save  those  questions  for  Dr.  Jaffe. 

Mr.  Brasco.  Thank  you. 

Mr.  Rangel.  My  last  question  is  do  you  know  of  any  reason  why  the 
Food  and  Drug  Administration  has  not  certified  this  drug? 

Dr.  Gearing.  I  think  they  are  overly  cautious,  to  put  it  mildly. 

Chairman  Pepper.  Any  other  questions  ? 

Thank  you  very  much,  Dr.  Gearing.  We  appreciate  your  valuable 
testimony  this  morning. 

(The  following  material,  previously  referred  to,  was  received  for 
the  record:) 

[Exhibit  No.   10(a)] 

Successes  and  Failures  in  Methadone  Maintenance  Treatment  of  Heroin 

Addiction  in   New   York  City 

(By  Frances  Rowe  Gearing,  M.D.,  M.P.H.  (Supported  under  Contract  No.  C- 
35806  from  New  York  State  Narcotic  Addiction  Control  Commission),  Associ- 
ate Professor,  Division  of  Epidemiology  Columbia  University  School  for  Public 
Health  and  Administrative  Medicine,  and  Director,  Methadone  Maintenance 
Evaluation  Unit) 

For  Presentation  at  Third  National  Conference  on  Methadone  Treatment,  Satur- 
day, November  14, 1970,  Park  Sheraton  Hotel,  New  York,  N.Y. 

introduction 

October  1  marks  the  fifth  anniversary  of  the  establishment  of  the  methadone 
maintenance  evaluation  unit  and  the  first  meeting  of  the  evaluation  committee. 
When  our  unit  began  operations  there  were  66  men  and  eight  women  in  the  pro- 
gram and  there  were  facilities  available  to  admit  approximately  seven  new 
patients  each  month.  As  time  has  marched  on,  the  progress  reports  from  our 
Evaluation  Unit  have  attempted  to  monitor  the  progress  of  the  program  with 
cautious  optimism,  with  the  result  that  we  have  been  quoted  and  misquoted  by 
legislators  at  all  levels  of  government  and  by  all  the  mass  media. 

Our  recommendation  for  continued  expansion  of  the  program  has  resulted  in 
a  veritable  population  explosion  in  the  past  year.  As  of  October  31,  1969,  the 
methadone  maintenance  treatment  programs  under  our  surveillance  included 
six  inpatient  induction  units,  and  ambulatory  induction  was  just  beginning.  The 

60-296  O— 71— pt.  1 9 


122 

admission  rate  was  approximately  50  patients  each  month,  equally  divided  be- 
tween ambulatory  and  inpatient  induction  with  rather  cautious  selection  of  those 
admitted  for  ambulatory  induction. 

This  year  has  seen  an  almost  complete  reversal  in  this  procedure.  The  vast 
majority  of  patients  are  currently  being  stabilized  on  an  ambulatory  basis,  and 
inpatient  services  are  used  only  for  those  patients  who  present  unusual  problems. 

As  of  October  31,  1970,  we  have  under  surveillance  13  inpatient  induction  units 
and  46  active  outpatient  and  ambulatory  units.  These  units  cover  the  four  largest 
New  York  City  boroughs  and  lower  Westchester  County.  How  many  patients 
are  involved?  Table  1  shows  the  October  31,  1970,  census.  There  have  been  4,376 
admissions  to  date,  and  3,485  patients  are  under  treatment.  This  is  contrasted 
with  the  census  as  of  October  31,  1969,  when  there  were  2,325  admissions  and 
1,886  patients  in  treatment.  This  highlights  the  rapid  expansion  from  approxi- 
mately 50  patients  per  month  to  a  level  of  50  new  patients  each  week.  The  loca- 
tions of  the  inpatient  and  outpatient  units  are  listed  in  appendixes  A  and  B  for 
those  who  are  interested.  The  rapid  induction  group  is  a  relatively  new  unit, 
opened  in  late  July  1970,  to  which  a  group  of  approximately  100  patients  from 
the  waiting  list  have  been  offered  ambulatory  induction  to  methadone  main- 
tenance with  medication  only  and  little  or  no  supportive  services  at  the  outset. 
The  success  rate  in  this  group  is  being  followed  with  great  interest  because  Its 
initial  objective  is  to  delineate  that  portion  of  the  accepted  patients  which  can 
be  maintained  with  only  minimal  supportive  services. 

DESCRIPTION    OF    SAMPLE 

The  age  distribution  of  patients  in  the  methadone  maintenance  treatment  pro- 
gram has  not  changed  substantially  over  the  past  5  years  despite  the  change  in 
age  criteria  for  admission.  This  appears  to  be  the  result  of  two  balancing  forces. 
These  are  (1)  the  inclusion  of  a  few  18-year-old  patients,  and  (2)  the  admission 
of  a  small  number  of  oriental  patients  who  are  in  their  late  50's.  Therefore,  the 
median  age  of  all  patients  remains  at  about  33.3  years  with  the  average  age  of 
the  black  patients  somewhat  older  (35.6) . 

The  ethnic  distribution  remains  approximately  40  percent  white,  40  percent 
black,  19  percent  Spanish  and  1  percent  oriental. 

We  will  discuss  the  "failures"  first. 

RATE   OF   DISCHARGE 

The  rate  of  discharge  by  month  of  observation  has  demained  amazingly  stable 
despite  the  changes  in  admission  criteria  and  the  change  of  emphasis  from  in- 
patient induction  to  ambulatory  induction.  This  is  illustrated  in  figure  1  where 
the  rates  of  discharge  for  the  two  groups  are  contrasted.  The  two  curves  are 
identical.  The  Van  Etten  group,  which  active  tuberculosis  as  an  additional  prob- 
lem to  heroin  addiction,  demonstrate  a  somewhat  accelerated  discharge  rate  as 
might  be  expected. 

In  figure  2  we  contrast  three  cohorts  of  500  patients  by  date  of  admission,  and 
once  again  we  find  no  difference  in  rates  of  discharge  among  these  three  cohorts 
representing  the  first  1,500  patients  admitted  to  the  program. 

Figure  3  contrasts  the  discharge  rate  for  men  and  women.  The  slight  difference 
shown  is  not  significant  due  to  the  much  smaller  number  of  women.  The  rate  of 
discharge  for  men  by  age  at  time  of  admission  is  shown  in  figure  4  and  once 
again  shows  no  difference  between  younger  and  older  patients.  A  small  difference 
appears  in  figure  5  between  the  rate  of  discharge  in  the  third  year  between 
black  and  white  patients.  This  difference  is  not  statistically  significant  at  this 
point  but  bears  monitoring  in  the  future. 

SEASONS     FOR   DISCHARGE 

As  shown  in  figure  6  problems  with  alcohol  abuse  as  a  reason  for  discharge 
increases  with  age  at  time  of  admission  for  both  men  and  women,  drug  abuse 
(primarily  amphetamines  and  barbiturates)  as  a  reason  for  discharge  decreases 
with  age  and  is  more  common  among  the  women  than  among  the  men.  Voluntary 
withdrawal  from  the  program  increases  with  age  particularly  among  the  men. 

Discharge  for  behavior  or  psychiatric  reasons  is  more  common  among  the 
younger  patients  of  both  sexes.  Deaths  follow  the  pattern  in  the  general 
population. 


123 

When  we  look  at  reasons  for  discharge  by  ethnic  group  as  shown  in  figure  7, 
we  note  that  alcohol  problems  are  more  common  among  the  black  patients  and 
drug  abuse  is  more  commonly  a  factor  among  the  white  and  Spanish  patients. 

Voluntary  withdrawals  and  discharge  for  behavioral  reasons  account  for  the 
majority  of  dropouts  in  the  first  year.  Chronic  problems  with  alcohol  abuse,  and 
continued  drug  abuse  were  the  major  causes  of  discharge  in  the  second  and  third 
year. 

FOLLOWUP  OF  DISCHARGED  PATIENTS 

With  the  assistance  of  two  medical  students,  (Michael  Lane,  Downstate  Medi- 
cal School,  and  Mary  Hartshorn,  Medical  College  of  Pennsylvania)  during  this 
past  summer,  we  completed  an  intensive  foUowup  on  a  sample  of  patients  who 
had  left  the  program.  We  selected  all  patients  who  were  discharged  alive  by 
December  31,  1969,  and  who  had  been  in  the  program  3  months  or  longer  at  the 
time  of  discharge.  This  gave  us  a  pool  of  562  persons.  We  divided  this  group  into 
two  segments:  (1)  those  who  had  left  the  program  voluntarily,  and  (2)  those 
who  had  been  discharged  from  the  program  for  cause. 

Our  primary  source  of  followup  was  the  New  City  Narcotics  Register  which 
receives  reports  from  the  police  and  correction  agencies,  hospitals,  and  treat- 
ment programs,  and  from  private  practitioners.  Another  very  useful  source  was 
a  series  of  interviews  with  patients  who  left  the  program  and  have  subsequently 
been  readmitted.  This  was  a  major  contribution  by  the  medical  students. 

For  the  sample  of  281  patients  on  whom  we  could  obtain  6  months  of  follow- 
up  the  results  are  shown  in  table  2. 

Those  patients  who  left  the  program  voluntarily  had  a  lower  arrest  and  de- 
toxification record,  than  the  rest.  They  also  had  a  larger  proportion  admitted 
to  other  treatment  programs  an  one-third  had  been  readmitted  to  the  program, 
contrasted  with  only  6  percent  of  those  discharged  for  cause.  If  one  considers 
that  no  record  found  is  roughly  equivalent  to  remaining  "clean,"  one-third  of 
this  group  were  still  "clean"  6  months  after  leaving  the  program. 

The  same  sampling  procedure  was  followed  for  the  396  patients  on  whom  we 
could  obtain  12  months  to  followup.  These  results  are  shown  in  table  3.  In  this 
group  only  21  percent  would  be  considered  still  "clean."  The  readmission  rate 
was  somewhat  lower  (13  percent).  Except  for  arrests  and  deaths  those  who  left 
the  program  voluntarily  are  very  similar  to  the  other  group. 

Table  4  shows  the  results  of  the  followup  on  our  sample  of  181  patients  on 
which  we  had  a  followup  of  1  year  or  more.  Here  the  readmission  rate  is  22 
percent  and  the  proportion  who  appear  to  have  remained  "clean"  is  only  18 
percent  and  the  death  rate  reaches  5  percent. 

These  data  would  tend  to  indicate  that,  among  those  patients  who  withdraw 
from  methadone  maintenance  treatment,  only  a  small  portion  have  been  able  to 
"make  it"  on  their  own. 

Because  of  the  tremendous  current  interest  in  "criminality"  associated  with 
addicition,  we  looked  into  the  previous  arrest  records  of  those  patients  who 
have  remained  in  the  program,  contrasted  with  those  who  left  the  program 
voluntarily,  and  those  who  were  discharged  for  cause.  We  contrasted  this,  in  a 
"before  and  after"  picture,  as  shown  in  figure  3.  It  is  interesting  to  note  that 
the  past  history  of  those  who  were  discharged  for  cause  with  reference  to  arrests 
is  worse  than  either  of  the  other  two  groups — and  that  their  behavior  following 
discharge  is  as  poor  or  worse  than  before  admission.  Those  who  left  voluntarily, 
demonstrate  a  short  preiod  of  improvement  but  also  tend  to  return  to  their 
previous  arrest  pattern.  Those  who  remained  in  the  program  show  a  constant 
and  accelei'ated  decline  in  criminal  behavior  as  measured  by  arrests. 
Enough  of  failures.  Now  let's  discuss  successes. 

CRITERIA    FOR    SUCCESS 

The  criteria  established  by  our  evaluation  unit  with  the  approval  of  the  evalua- 
tion committee  for  measuring  success  of  the  program  has  resolved  around  four 
basic  measures : 

(1)  Freedom  from  heroin  "hunger"  as  measured  by  repeated,  periodic  "clean" 
urine  specimens. 

(2)  Decrease  in  antisocial  behavior  as  measured  by  arrest  and/or  incarcera- 
tion (jail). 

(3)  Increase  in  social  productivity  as  measured  by  employment  and/or  school- 
ing or  vocational  training. 

(4)  Recognition  of,  and  willingness  to  accept  help  for  excessive  use  of  alcohol, 
other  drugs,  or  for  psychiatric  problems. 


124 

BESULTS 

(1)  Although  many  of  the  patients  test  the  methadone  "blockade"  of  heroin 
one  or  more  times  in  the  first  few  months,  less  than  1  percent  have  returned 
to  regular  heroin  usage  while  under  methadone  maintenance  treatment. 

(2)  Antisocial  behavior  as  measured  by  arrests  and  incarcerations  (jail)  have 
been  looked  at  in  several  ways.  First,  the  percentage  of  arrests  among  patients 
in  the  program  during  the  3  years  prior  to  admission  was  compared  with  the  per- 
centage of  arrests  of  these  same  persons  following  admission.  This  "before  and 
after"  picture  is  also  contrasted  with  the  proportion  of  arrests  in  a  contrast  group 
of  100  men  selected  from  the  detoxification  unit  at  Morris  Bernstein  Institute 
matched  by  age  and  ethnic  group  and  followed  in  the  same  manner.  The  results 
are  illustrated  in  figure  9.  The  arrest  records  of  these  two  groups  are  quite  simi- 
lar for  each  year  of  observation  prior  to  admission.  Following  admission  to  the 
program,  the  contrast  is  striking  for  each  period  of  observation  with  the  metha- 
done maintenance  patients  showing  a  marked  decrease  in  the  percentage  of 
patients  arrested,  and  the  contrast  group  showing  a  pattern  very  similar  to  the 
earlier  period  of  observation. 

We  have  also  calculated  the  arrests  per  100  patient-years  of  observation  for  the 
3  years  prior  to  admission  in  contrast  to  the  arrests  per  100  patient-years  of 
observation  after  admission.  We  have  compared  these  data  using  the  same  com- 
putations for  the  contrast  group.  The  results  are  shown  in  table  5.  These  results 
would  appear  to  indicate  that  remaining  in  the  methadone  maintenance  program 
does  indeed  decrease  antisocial  behavior  as  measured  by  arrests  or  incarcerations. 

(3)  Increased  social  productivity  can  best  be  illustrated  by  the  employment 
profiles  shown  in  figures  10  and  11.  There  is  a  steady  and  rather  marked  increase 
ii  the  employment  rate  with  a  corresponding  decrease  in  the  percentage  of 
patients  on  welfare  as  time  in  the  program  increases.  This  is  true  both  for  the 
men  and  the  women.  These  data  include  both  ambulatory  and  inpatient  induc- 
tion groups.  This  accounts  for  the  increased  percentage  of  men  employed  at  time 
of  admission  since  this  was  one  of  the  early  criteria  for  admission  to  an  ambula- 
tory unit. 

(4)  Figure  12^  is  an  attempt  to  illustrate  stability  of  employment  among 
patients  remaining  in  the  program  as  contrasted  with  their  previous  employment 
experience.  The  shaded  area  might  be  considered  as  a  measure  of  their  increased 
social  productivity  since  admission  to  the  program. 

(5)  Although  chronic  alcohol  abuse  continues  to  be  a  problem  for  approxi- 
mately 8  percent  of  the  patients  (both  men  and  women),  and  for  some  becomes 
the  principal  reason  for  discharge,  a  majority  of  these  patients  show  continued 
improvement  in  their  ability  to  handle  their  alcohol  problem  with  the  support 
and  assistance  of  members  of  the  program  staff  who  recognize  the  problem,  and, 
are  willing  and  able  to  cope  with  it. 

(6)  Problems  with  chronic  abuse  of  drugs  such  as  barbiturates,  amphetamines, 
and  more  recently  cocaine  are  evident  in  approximately  10  percent  of  the  patients. 
There  again,  for  some,  it  has  resulted  in  discharge  from  the  program.  For  many 
othets,  the  patients  are  able  to  function  satisfactorily,  with  the  assistance  and 
support  of  members  of  the  program  staff. 

CONCLUSIONS 

On  balance,  the  successes  in  the  methadone  maintenance  treatment  program 
far  outweigh  the  failures.  The  rapid  expansion  of  the  program  during  the  past 
year,  and  the  change  in  emphasis  to  include  primarily  ambulatory  induction 
under  the  expanded  admission  criteria  does  not  appear  to  have  made  any  notice- 
able change  in  the  effectiveness  of  this  treatment  for  those  heroin  addicts  who 
have  been  accepted  into  the  program.  A  majority  of  the  patients  have  completed 
their  schooling  or  increased  their  skills  and  have  become  self-supporting.  Their 
pattern  of  arrests  has  decreased  substantially.  This  is  in  sharp  contrast  to  their 
own  previous  experience,  as  well  as  their  current  experience  when  compared  with 
a  matched  group  from  the  Detoxification  unit,  or  when  compared  with  those 
patients  who  have  left  the  program.  Less  than  1  percent  of  the  patients  who 
have  remained  in  the  program  have  reverted  to  regular  heroin  use. 

A  small  proportion  of  the  patients  (10  percent)  persent  continued  evidence  of 
drug  abuse  involving  use  of  amphetamines,  barbituarates,  and  cocaine,  and 
another  8  percent  demonstrate  continued  problems  from  chronic  alcohol  abuse. 
These  two  problems  account  for  the  majority  of  failures  in  rehabilitatin  after  the 
first  6  months. 


125 

Methadone  maintenance  as  a  treatment  modality  was  never  conceived  as  a 
"magic  bullet"  that  would  resolve  all  the  problems  of  patients  addicted  to  heroin. 
For  this  reason,  we  believe  that  any  treatment  program  using  methadone  mainte- 
nance must  be  prepared  to  provide  a  broad  variety  of  supportive  services  to 
deal  with  problems  including  mixed  drug  abuse,  chronic  alcoholism,  psychiatric 
or  behavioral  problems,  and  a  variety  of  social  and  medical  problems. 

Many  questions  continue  to  remain  unanswered  with  reference  to  the  role  of 
methadone  maintenance  in  the  attack  on  the  total  problem  of  heroin  addiction ; 
nevertheless  the  data  presented  on  the  group  of  patients  who  have  been  ad- 
mitted to  this  methadone  maintenance  treatment  program  continues  to  demon- 
strate that  this  program  has  been  successful  in  the  vast  majority  of  its  patients. 

After  a  careful  review  of  the  data  related  to  successes  and  failures  over  the 
past  5  years,  the  methadone  maintenance  evaluation  conmiittee  has  submitted 
the  following  recommendations  as  of  Friday,  November  6,  1970 : 

KECOMMENDATIONS 

As  a  result  of  the  continued  encouraging  results  in  the  methadone  maintenance 
treatment  program  through  October  31,  1970,  the  methadone  maintenance  evalu- 
ation committee  recommends : 

(1)  That  there  be  continued  financial  support  for  the  methadone  mainten- 
ance treatment  program  to  allow  continued  intake  of  new  patients  using  ad- 
mission criteria  including  a  minimum  age  of  18  years  and  a  history  of  a  mini- 
mum of  2  years  of  addiction  with  care  in  selection  of  patients  to  prevent  the 
possibility  of  addicting  an  individual  to  methadone  who  is  not  physiologically 
addicted  to  heroin. 

(2)  That  there  be  continued  evaluation  of  the  long-term  effectiveness  of  the 
methadone  maintenance  treatment  program  for  the  group  stabilized  on  art  in- 
patient basis,  the  group  being  stabilized  on  an  ambulatory  basis,  and  the  group 
undergoing  rapid  induction. 

(3)  That  new  programs  which  plan  to  use  methadone  maintenance  should  in- 
clude all  eleemnts  of  the  program  including : 

(c)  Availability  of  adequate  facilities  for  the  collection  of  urine  and  labor- 
atory facilities  for  frequent  and  accurate  urine  testing. 

(&)  Medical  and  phychiatric  supervision. 

(c)  Backup  hospitalization  facilities. 

id)  Adequate  staff  including  vocational,  social,  and  educational  support 
and  counseling. 

(e)  Rigid  control  of  methods  of  dispensing  methadone  and  number  and 
size  of  aoses  given  for  self -administration  in  order  to  prevent  diversion  to 
illicit  sale  or  possible  intravenous  use. 

(/)  Staff  members  of  potential  new  programs  planning  to  use  methadone 
maintenance  be  trained  in  this  technique  in  a  medical  center  which  has 
been  shown  to  use  methadone  maintenance  effectively. 
4.  That  continued  research  is  essential  particularly  with  reference  to : 

(c)  The  role  of  methadone  maintenance  in  the  treatment  of  young  heroin 
addicts  ( under  18 ) . 

(&)   Developing  programs  using  methadone  maintenance  in  combination 
with  other  approaches  to  the  treatment  of  heroin  addiction. 
Projects  in  these  areas  should  be  supported  and  encouraged,  but  must  be  con- 
sidered new  research  studies,  and  should  be  subjected  to  the  same  surveillance, 
and  independent  evaluation  as  the  current  programs. 

(5)  That  methadone  maintenance  not  be  considered  at  this  time  as  a  method 
of  treatment  suitable  for  use  by  the  private  medical  practitioner  in  his  office 
practice,  because  of  the  requirements  for  other  program  components  including 
social  rehabilitation  and  vocational  guidance. 

(6)  That  a  pilot  or  demonstration  project  be  developed  involving  the  use  of 
properly  trained  practicing  phy.sicians  as  an  extension  of  an  organized  methadone 
maintenance  treatment  program  to  treat  those  patients  whose  needs  for  ancillary 
services  are  minimal.  These  patients  should  be  continued  under  the  supervision 
of  the  methadone  maintenance  treatment  program  for  periodic  evaluation  and 
urine  testing. 

ACKNOWLEDGMENTS 

1.  The  members  of  the  methadone  maintenance  evaluation  committee,  both  past 
and  present  with  particular  reference  to  Dr.  Henry  Brill,  who  has  so  aptly 
chaired  that  committee  since  its  inception. 


126 

2.  All  the  members  of  the  methadone  maintenance  treatment  program  staff  for 
their  devotion  to  their  job  and  for  their  cooperation  whenever  needed. 

3.  The  staff  of  the  Rockefeller  Data  Bank  especially  Dr.  Alan  Warner  and 
Mrs.  Ellen  Smith  for  their  willingness  to  make  available  to  us,  whenever  re- 
quested, data  which  has  been  a  crucial  starting  point  of  our  evaluation. 

4.  Those  medical  students  who  have  made  substantial  contributions  to  our 
efforts  over  the  past  4  years. 

5.  The  directors  of  the  New  York  City  Narcotics  Register  who  have  allowed 
us  to  use  their  data  for  validation  and  for  followup.  These  listed  in  chronological 
order  over  the  past  5  years  are :  Dr.  Florence  Kavaler,  Mrs.  Zili  Amsel,  Miss  Joy 
Fishman,  Mr.  Sherman  Patrick. 

6.  The  diligence  and  devotion  of  my  staff  including :  Mrs.  Dina  D'Amico,  Mrs. 
Angela  del  Campo.  Mrs.  Frieda  Karen,  Miss  Elaine  Keane,  Mrs.  Dorothy  Mad- 
den, Mrs.  Ingel  Mayer. 

7.  And  last  but  not  least  to  the  New  York  State  Narcotic  Addiction  Control 
Commission  for  funding  our  efforts. 


127 


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128 


HETHADOHE  MAINTENANCE  TREATMENT  PROGRAM 

Rate  of  Discharge  by  Month  for  Patients  Inducted  on  an  Ambulatory  Basis 

Versus  In-Patient  Induction  and  Van  Etten 

as  of  June  50,  1170 


n=  1921 

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Figure  2 


Methadone  Maintenance  Treatment  Program 

Rate  of  Discharge  by  Month  for  Three  Successive  Cohorts  of  500  Patients 
By  Dote  of  Admission 


kO 


Cohort  #1  =  • ' 

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12   15  18 


21  2k      27   30  33   36   39   1(2  1*5 

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129 


Figure  3 


METHADONE  MAINTENANCE  TREATHEIIT  PROGRAM 

Rate  of  Discharge  by  Month  for  Men  versus  Vtonen 
as  of  June  30,    1970 


100- 
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Women  n=     537 


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10- 


Methadone  Maintenance  Treatment   Program 

Rate  of  Discharge  by  Hcnth   for   2835  Men  by  Ag?   at   Time  of  Admission 
as  of  June  30,    1970 


— r- 
12 


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Months 


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11/18/70 


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130 


Methadone  Halnten?nce  Treatment  Program 

Rate  of  Discharge  by  Month  for  ?306  Men  by  Ethnic  Group 
as  of  June  JO,  1970 


10 


11/' 0/70 


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=  Black   n=I122 


0    3     6     9 


"1 1 1 1 1 1 1 1 1 1 

12    15    18    21    2i)    27    30    33    36 

Months 


Figure  6  METHADOflE  MAIMTEMANCE  TREATMENT  PROGRAM   . 

Percentage  Distribution  of  Principal  Reason  for  Discharge  of  718  Patients  by  Age  at  Time  of  Admission 


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Alcohol       Arrests 


Drugs       Voluntary     Tehavior 


Death 


11/10/70 


131 

Figure  7  METHADONE  HAINTEHAHCE  TREATMENT  PROGRAM 

Percentacje  Distribution  of  Principal  "eason  for  discharge  of  710  Patients  by  Ethnic  Group 


"lO- 


c   20- 


i 


r-^ 


A)  Women  n=  1 19 


i 


m 


Alcohol        Arrests        Drugs        Voluntary     "ehavior       Death 


Jia 


20- 


1 


i 


B)    Men   n=   599 


D 


Black 


V/hite 


Spanish 


n^ 


Alcohol        Arrests        Drugs        Voluntary     Behavior 


Death 


11/10/70 


132 


TABLE  2.-METHAD0NE  MAINTENANCE  TREATMENT  PROGRAM 
IFollowup  of  281  patients  6  months  following  discharge  from  M.M.T.P.;  in  percent] 


Left 

volun- 
tarily 

Dis- 
charged 
for  cause 

Total 
dis- 
charge 

Left 

volun- 
tarily 

Dis- 
charged 
for  cause 

Total 
dis- 
charge 

Arrest  or  jail 

Dead 

Detoxification 

Other  Rx  program 

Medical  or  psychiatric 
facility  .              

10 

2 

13 

11 

2 

26 
2 

20 
4 

3 
2 

23 

2 

19 

7 

2 
2 

Moved 

Readmitted 

No  reports  found 

Total  sample 

Total  N.. 

7 

33 
22 

1 

6 

36 

1 

11 
33 

.       45/100 
.       90 

236/100 
472 

281/100 
562 

Private  medical  doctor. . 

TABLE  3.— METHADONE  MAINTENANCE  TREATMENT  PROGRAM 
IFollowup  of  198  patients  up  to  1  year  after  discharge  from  M.M.T.P.;  in  percent] 


Left 
volun- 
tarily 

Dis- 
charged 
for  cause 

Total 
dis- 
charge 

Left 
volun- 
tarily 

Dis- 
charged 
for  cause 

Total 
dis- 
charge 

Arrester  jail 

Dead 

Detoxification 

Other  Rx  program 

Medical  or  psychiatric 

facility 

Private  M  D 

13 

34" 

6 

3 
3 

28 
2 

23 
6 

4 

1 

25 
2 

25 
6 

4 
2 

Moved 

Readmitted 

No  reports  found 

Total  sample 

Total  N 

25 

2 
13 
21 

2 
13 
21 

.      32/100 
.      64 

166/100 
232 

198/100 
396 

TABLE  4.-METHAD0NE  MAINTENANCE  TREATMENT  PROGRAM 
[Followup  of  181  patients  1  year  or  more  after  discharge  from  M.M.T.P.;  in  percent] 


Arrest  or  jail. 

Dead 

Detoxification 

Other  Rx  program 

Medical  or  psychiatric 

facility.. 

Private  M.D.. 


Left  Dis- 

volun-      charged 

tarily    for  cause 


18 


37 
11 

6 
6 


30 
5 

27 
11 

7 
3 


Total 

dis- 
charge 


28 
5 

28 
22 

7 
3 


Left  Dis- 

volun-      charged 

tarily    for  cause 


No  reports  found. 
Readmitted' 


21 
129 


17 
121 


Total  sample 28/100      153/100 

Total  N 56  306 


Total 
dis- 
charge 


18 
122 


181/100 
362 


>  Readmitted  patients  each  had  1  or  more  reports  of  arrest  or  detoxification. 


Figure  8 


133 


HETHAOOIIE  MArMTCMArXE  JREMIW.'T   PROGRAM 


Comparison  of  Arrest  Records  Amonn  Persons 
Continuing  and  Oischarcerl  from  Methadone  Maintenance  Treatment  Program 


Prior  to  Admission 


a   -  Since  Admission 
■^    b  £  c  -  Since  Discharge* 


years 


'  years  ^ 


n  ".MP  ,  (2560)  (2560) 
n  Vol.Dis.  CtS)  CtS) 
n  lnvol.Dis.(23f>)    (23&) 


(2560)      (2560)      OSA'.)      (788)      iiBt*) 
('•5)        (AS)        (32)       (20 
(236)      (236)      (166)      (153) 


*AI1  discharges  had  participated  in  HMTP  for  at  least  90  days  prior  to  discharge. 
10/26/70 


Figure  9 


134 


Methadone  tlaintenance  Treatment  Progran 


Percentage  Distribution  of  Arrests  for  2G'»1  Men  In  Methadone  Maintenance  Program 

Three  Months  or  Longer  as  of  Harch  31,  K-?")   and  Contrast  Group 

5y  Months  of  Observation 


DEFORE  <- 


START 


^  AFTER 


Percentage 
30-1 


20- 


10- 


Year  Prior  to  Admission 
to  Program 


Year  After  Admission 
to  Program 


n  MMP            (28'il) 

(23'il) 

(28'»J) 

(281)1) 

(15'*'.) 

(788) 

OSM 

n  Contrast    (100) 

(100) 

(100) 

(100) 

(98) 

(95) 

(92) 

11/10/7^ 

135 

TABLE  5.— METHADONE  MAINTENANCE  TREATMENT  PROGRAM 

iThe  Number  of  Arrests  and  Incarcerations  per  100  Person-Years  for  Methadone  Maintenance  Patients  Before  and  After 
Admission  Contrasted  With  Patients  From  Detoxiflcation  Unit] 

Methadone      Detoxification 
group  group 

Before  admission: 

Arrestsper  100  person-years 115  131 

Jail  per  100  person-years... 49  52 

N=person-years 17,500  600 

Following  admission: 

Arrestsper  100  person-years 4.3  135 

Jail  per  100  person-years 1.0  63 

N=person-years 10,800  1,040 


136 


Figure  10 


Methadone  Ka'ntanance  Treatmf:nt  Program 

EfTipIoyment  Status  and  School  Attendance  for  Men  in  Metiadone  Maintenance 

Three  Months  or  Longer  as  of  March  3'.  '970 

(In-Patient  and  Ambulatory  Induction 


00-                  ^ 

^ 

^ 

^ 

:^ 

^ 

^ 

^ 

-_ 

1 

— 1 

— 1 

— 1 

80-                 

/ 

^32 



' 

= 

— 

^ — 

— 

/   y 

[ ' 

60  -               / 

•      y/^ 

// 

/  / 

/  / 

"tO   -11 

20  _ 
0    -                  

• 

School 
Welfare 


Supported  by 
Others 


Employed 


6  Months   12  Months   18  Months   Ih   Months   30  Months   36  Months   'i2  Months   A8  Months 
Months  Following  Admission  to  Program 
n-  (I97lt)      (1807)       (1330)      (891)       (650)       (468)       (330)       (203)       (R1) 


11/9/70 


Figure  II 


Methadone  Haintensnce  Treatmant  Program 

Employment  Status  and  School  Attendance  for  '(66  Women  in  Methadone  Maintenance 
Three  Months  or  Longer  as  of  'l.-.rch  ?1,  WT^ 
(In-Patlent  and  Ambulatory  Induction) 


100 


11/10/70 


n=  (1)66) 


VsM  School 


Welfare 


Homemsker 


Employed 


6  Months   12  Months   18  Months   2't  Months   30  Months   36  Months 
Months  Following  Admission  to  Program 
(JitS)      (2i.5)      (161)      (109)      (71)       (A5) 


137 


Figure  12  Methadone  Maintenance  Treatment  Program 

Percent  of  Pcrson-fonths  of  Observation  During  Which  Mon  in  Program  l/ere  Employed 
Defore  and  After  Admission  by  Duration  of  Employment 
as  of  July  31,  '963 


Increase  of  Observed 
Over  Expected 


*  F   1    A        Person-Months  of  Employment 

*  Einployed  =  Person-Months  of  Observation 


Sli   Months 
'/]  51  Months 


%   Employed 
Prior  to  Admission 


%   Employed 
Following  Admission 


ADMISSION  TO  PROGRAM 


11/10/70 


60-296  O  -  71  -  pt.  1  -  10 


138 


Appendix  A^ — Methadone  Maintenance  Treatment  Program 
Inpatient  Induction  Units  by  County  as  of  October  31, 1970 

Manhattan : 

Grade  Square  Hospital  (men  and  women). 

Harlem  Hospital  (men). 

Morris  J.  Bernstein  Institute  (men  ad  women). 

Riker's  Island  (men). 

Rockefeller  University  Hospital  (men  and  women). 

Roosevelt  Hospital  (men  and  women). 

St.  Luke's  Hospital  (men  and  women). 
Bronx : 

Albert  Einstein  Medical  Center  ( men  and  women ) . 

Bronx  State  Hospital  (men  and  women) . 
Brooklyn  :  Brookdale  Hospital  (men  and  women). 
Westchester  County : 

St.  Joseph's  Hospital  (men  and  women). 

White  Plains  Hospital  (men  and  women). 

Yonker  General  Hospital  (men  and  women). 


Appendix  B — Methadone  Maintenance  Treatment  Program 
Outpatient  and  ambulatory  induction  units  by  county  as  of  October  31, 1970 


Number 
of  units 
Manhattan : 

City  Probation 2 

Gracie  Square  Hospital 1 

Greenwich    House 1 

Harlem  Hospital 5 

Jewish  Memorial  Hospital 1 

Morris  J.  Bernstein  Institute 1 

Lower  East  Side 10 

Lower  West  Side 2 

Rapid   Induction 1 

Mount  Sinai  Hospital 1 

Rockefeller  University 

Hospital 2 

Roosevelt  Hospital 1 


St.  Luke's  Hospital- 
St.  Vincent's  Hospital. 
Bronx : 

Bronx  State  HospitaL. 

Lincoln  Hospital 

Van  Etten  Hospital— 


1 
1 

1 
1 
1 


Number 
of  units 
Brooklyn  : 

Brookdale  Medical  Center 1 

Coney  Island  Hospital 2 

Cumberland  Hospital 2 

Lutheran    Hospital 1 

Methodist  Hospital 1 

Queens : 

Long  Beach  Memorial 

Hospital 

Triboro  Hospital 

Westchester : 

St.  Joseph's  Hospital 1 

White  Plains  Hospital 

Yonkers  General  Hospital 

Yonkers  Public  Health  Build- 
ing  (WCCMHB) 


1 
2 


1 
1 


[Exhibit  No.   10(b)] 
Position  Papek  :  Methadone: — A  Valid  Treatment  Technique 

(By  Frances  Rowe  Gearing,  M.D.,  M.P.H.  (Supported  under  Contract  No.  C-35806 
from  New  York  State  Narcotic  Addiction  Control  Commission),  Associate 
Professor,  Division  of  Epidemiology,  Columbia  University  School  of  Public 
Health  and  Administrative  Medicine,  and  Director,  Methadone  Maintenance 
Evaluation  Unit) 

For  Presentation  at  State  Conference  on  "Drugs — The  Issues  on  Trial," 
Pontiac,  Mich.,  December  2,  1970 

Position   Paper — Methadone  Maintenance  :   a  Valid  Treatment  for 

Heroin   Addiction? 

My  answer  to  this  question  is  yes  when  properly  administered  in  an  organized 
methadone  maintenance  treatment  program. 
There  are  at  least  five  basic  reasons  for  my  positive  response  which  I  list: 


139 

1.      DRUG    PKOPEKTIES 

Methadone  has  several  properties  which  make  it  useful  as  a  treatment  for 
heroin  addicts.  These  properties  includes  the  following  : 

(a)  It  is  a  longer  acting  drug  than  heroin.  Patients  on  methadone  mainten- 
ance, after  a  relatively  short  induction  period,  require  only  one  dose  a  day.  This 
contrasts  with  four  to  six  fixes  a  day  for  the  patient  "hooked"  on  heroin. 

(&)  Methadone  is  given  by  mouth  in  noninjectable  form.  This  alone  makes  it 
most  attractive  from  a  medical  standpoint,  because  it  is  well-known  that  many 
of  the  medical  problems  of  heroin  addicts  are  related  to  intravenous  injection 
without  proper  sterilization  techniques.  These  problems  include,  hepatitis,  endo- 
carditis, tetanus,  and  a  plethora  of  other  medical  problems. 

(o)  Patients  on  methadone  can  be  gradually  built  up  to  a  stabilizing  dose  of 
between  80-120  mgs.  daily,  and  can  be  maintained  at  this  level  over  periods  of 
time  up  to  5  years  without  having  to  alter  the  dosage  level.  This  is  in  sharp 
contrast  to  the  addict's  experience  with  heroin.  Patients  on  heroin  rapidly  de- 
velop a  tolerance  to  the  ordinary  street  "bag"  to  the  point  where  they  have 
eitlier  to  increase  the  number  of  bags  for  each  "fix"  and  increase  their  hustling 
in  order  to  get  more  "bags"  more  often  to  support  their  needs,  or  to  apply  at  a 
detoxification  unit  for  a  drying-out  period  which  will  bring  them  back  on  the 
street  within  2  weeks  with  a  less-expensive  habit. 

(d)  Methadone  maintenance  when  used  at  high  dosage  levels  produces  a 
"blockade"  against  the  effect  of  heroin  which  might  be  referred  to  as  heroin 
"euphoria."  Under  carefully  controlled  circumstances,  patients  stabilized  on 
methadone  maintenance  given  by  mouth  have  demonstrated  that  this  blockage 
is  effective  even  with  high  doses  of  pure  heroin. 

(e)  The  long-term  medical  effects  of  methadone  maintenance  are  minimal. 
This  statement  is  based  on  a  careful  medical  followup  of  a  series  of  80  patients 
who  have  been  on  80-120  mgs.  of  methadone  daily  for  a  period  of  over  5  years. 

These  properties  make  methadone  a  very  useful  tool  in  the  treatment  and 
rehabilitation  of  patients  addicted  to  heroin  for  the  basic  reason  that  it  gives 
former  heroin  users  a  chance  to  use  their  time  in  a  more  productive  way.  Under 
methadone  maintenance  they  are  relieved  of  the  problem  of  spending  most  of 
their  waking  hours  in  hustling  for  means  to  get  their  next  "fix."  This  difference 
might  be  equated  with  the  difference  between  the  old  insulin  treatment  for  di- 
abetes patients  which  involved  three  to  four  injections  per  day  based  on  urnie 
samples.  The  new  look  in  diabetes  treatment  is  more  apt  to  be  one  injection  a  day 
of  long  acting  insulin  or  control  by  medication  which  can  be  administered  orally. 

2.    REHABILITATION — EMPLOYMENT    AND    SCHOOLING 

Patients  on  methadone  maintenance  can  remain  in  their  local  community  with 
their  family  or  peer  groups  throughout  their  treatment.  They  are  encouraged 
and  offered  considerable  assistance  by  members  of  the  program  staff  to  complete 
their  basic  education  at  least  through  high  school,  to  acquire  a  skill  through 
additional  vocational  training,  to  becoming  a  wage  earner  and  hopefully  become 
self-supporting. 

These  objectives  have  been  achieved  in  a  majority  of  the  patients  in  the  metha- 
done maintenance  treatment  program  in  New  York  City  as  illustrated  by  the 
employment  profiles  by  men  and  women  in  figures  1  and  2.  There  is  a  steady  and 
rather  marked  increase  in  the  employment  rate  with  a  corresponding  decrease 
in  the  percentage  of  patients  on  welfare  as  time  in  the  program  increases.  This 
is  true  both  for  the  men  and  the  women. 

3.    CRIMINALITY 

Patients  on  methadone  maintenance  have  demonstrated  a  rather  striking 
change  in  their  antisocial  behavior  as  measured  by  arrests  as  shown  in  figure  3, 
where  the  percentage  of  arrests  among  patients  in  the  methadone  maintenance 
treatment  program  is  contrasted  with  their  arrest  experience  for  the  3  years 
prior  to  adminission  and  this  "before  and  after"  picture  is  contrasted  with  the 
proportion  of  arrests  in  a  contrast  group  of  men  selected  from  the  detoxification 
unit  at  Morris  Bernstein  Institute  matched  by  age  and  ethnic  group  and  followed 
over  the  same  period.  The  arrest  records  of  the  two  groups  are  quite  similar  for 
each  year  of  observation  prior  to  admission.  FoUwing  admission  to  the  program 
the  contrast  is  vivid  for  each  period  of  observation  with  the  methadone  mainte- 


140 

nance  treatment  patients  showing  a  constant  and  accelerated  decline  in  criminal 
behavior  and  the  contrast  group  showing  a  pattern  very  similar  to  the  earlier 
period  of  observation. 

4.    SUPPORTIVE   SERVICES 

Patients  on  methadone  maintenance  have  available  to  them  on  demand  one 
or  more  members  of  the  program  staff  who  are  ready,  willing,  and  able  to  re- 
spond to  their  needs  whether  these  needs  be  medical,  psychiatric,  vocational, 
social,  or  legal. 

5.    PROGRAM    PHILOSOPHY 

Treatment  programs  for  heroin  addiction  using  methadone  maintenance  have 
accepted  the  fact  that  the  "hard-core"  addicts  have  a  chronic  disease,  and,  there- 
fore, need  medication  and  support  over  a  long  period  of  time,  if  not  for  life. 

This  philosophy  has  resulted  in  a  more  permissive  attitude  toward  patients 
who  show  evidence  of  recurrent  abuse  of  other  drugs  such  as  barbiturates  and 
amphetamines  or  continued  chronic  alcohol  abuse,  and  every  effort  is  made  to 
assist  the  patients  in  handling  these  problems.  Only  when  this  support  fails  are 
patients  dropped  from  the  program. 

CONCLUSION 

Methadone  maintenance  is  a  valid  treatment  for  those  hard-core  addicts  who 
are  18  years  or  older  with  a  history  of  at  least  2  years  of  addiction  and  who 
have  had  difficulties  in  adjusting  to  the  stringencies  of  abstinence  programs. 
Among  patients  selected  in  this  manner  methadone  maintenance  has  proved 
successful  in  80  percent  of  more  than  4,000  patients  in  the  New  York  City  metha- 
done maintenance  treatment  program.  A  majority  of  the  patients  have  com- 
pleted their  schooling  or  increased  their  skills  and  have  become  self-supporting. 
Their  pattern  of  arrests  has  decreased  substantially.  This  is  in  sharp  contrast 
to  their  own  previous  experience,  as  well  as  their  current  experience  when  com- 
pared with  a  matched  group  from  the  detoxification  unit,  or  when  compared  with 
those  patients  who  have  left  the  program.  Less  than  1  percent  of  the  patients 
who  have  remained  in  the  program  have  reverted  to  regular  heroin  use.  No  other 
treatment  program  can  demonstrate  a  better  rate  of  success. 

Methadone  maintenance  as  a  treatment  modality  was  never  conceived  as  a 
"magic  bullet"  that  would  resolve  all  the  problems  involved  in  heroin  addic- 
tion. For  this  reason,  we  believe  that  any  treatment  program  using  methadone 
maintenance  must  be  prepared  to  provide  a  variety  of  supportive  services  to  deal 
with  such  problems  as  mixed  drug  abuse,  chronic  alcoholism,  as  well  as  psychia- 
tric or  behavioral  problems  and  a  variety  of  other  social  and  medical  problems. 
Therefore,  methadone  maintenance  should  not  be  considered  as  a  method  of 
treatment  suitable  for  use  by  the  private  medical  practitioner  in  his  office  prac- 
tice, because  of  the  requirements  for  other  program  components  including  social 
rehabilitation  and  vocational  guidance. 


141 


Figure  I 


Methadone  Maintenance  Treatment  Program 

Employnent  Status  and  School  Attendance  for  15-:6  i-ien  in  Methadone  Maintenance 
Three  Months  or  Lcnqer  as  of  March  31.  1*^70 
(In-Patient  Induction) 


100— 


80- 


fo- 


w_ 


20- 


0- 


v\- 

, ^ 

s^^ 

>^:;l             ^ 

ii^ 

;nV 

\v 

^ 

/ 

Welfare 


Employed 


n=  (13i6) 


C  .or.ths   12  Monfis   18  Months   i'4  Mcr.ths   30  Months   35  Months   hi   Months   U%   Months 
Month:  Fcllowing  Adrnission  to  Program 
.-23)       (•.;7J)       (77M       (606)       (IjSA)       (330)       (203)       (31) 


\'in(>na 


Figure  2 


Methadone  Maintenance  Treatment  Program 

Employment  Status  and  School  Attendance  for  ^S6  Vtomen  in  Methadone  Maintenance 
Three  Months  or  Longer  as  of   ''arch  '1,  l-'?" 
(In-Patient  and  Ambulatory  Induction) 


100— 


11/10/70 


(':!i£) 


'vTsi  School 


V/el  fare 


Homemaker 


Employed 


6  Months   12  Months   18  Month;   Ik   Months   30  Months   36  Months 
Months  Following  Admission  to  Program 
(3^5)        (2^5)        (161)        (10?)        (71)        Ct?) 


142 


Figure  3 


•lethadone  Kaintenance  Treatment  Program 


Percentage  Distribution  of  Arrests  for  2u'»I  '';en  in  Methadone  f'aintenance  Program 

Three  Months  or  Longer  as  of  'jrch  31,  ''7"^   arid  Contrast  Group 

^y  Mor.ths  of  Observation 


CEFORE  <- 


START 


-^  AFTER 


Percentage 

3r-i 


20- 


10- 


Year  Prior  to  Admission 
to  Program 


Year  After  Admission 
to  Program 


n  (IMP             (ZSkl) 

(2341) 

(2841) 

(2841) 

(1544) 

(780) 

(384) 

n  Contrast    (100) 

(100) 

(100) 

(100) 

(98) 

(95) 

(92) 

11/10/70 

143 

Chairman  Pepper.  Our  next  witness  is  Dr.  Robert  L.  DuPont,  Di- 
rector of  the  District  of  Columbia  Narcotics  Treatment  Administra- 
tion since  its  creation  in  February  1970. 

Dr.  DuPont,  a  young  man  with  impressive  credentials  in  medicine 
and  phychiatry,  has  been  changed  with  implementing  Mayor  Wash- 
ington's pledge  to  have  treatment  available  to  every  heroin  addict  in 
the  District  of  Columbia  within  3  years. 

Prior  to  assuming  his  present  position,  Dr.  DuPont  was  Associate 
Director  for  Community  Services  in  the  D.C.  Department  of 
Corrections. 

In  that  capacity,  Dr.  DuPont  participated  in  the  preparation  of  a 
report  that  revealed  that  some  45  percent  of  all  men  brought  to  the 
District  of  Columbia  jail  in  August  1969,  were  heroin  addicts. 

Since  then.  Dr.  DuPont  has  used  the  word  "epidemic"  to  describe 
heroin  addiction  in  the  District. 

Dr.  DuPont  is  a  graduate  of  Emory  College  in  Atlanta  and  the 
Harvard  University  Medical  School.  He  served  his  medical  internship 
at  the  Cleveland  Metropolitan  General  Hospital  and  his  residency  in 
psychiatry  at  the  Massachusetts  Mental  Health  Center,  Harvard 
University. 

For  2  years,  Dr.  DuPont  served  in  research  and  clinical  psychiatry 
at  the  National  Institute  of  Mental  Health. 

Dr.  DuPont,  we  are  glad  to  have  you  again  before  this  committee. 

STATEMENT  OF  DR.  ROBERT  L.  DUPONT,  DIRECTOR,  DISTRICT  OF 
COLUMBIA  NARCOTICS  TREATMENT  ADMINISTRATION 

Dr.  DuPont.  Thank  you,  Mr.  Chairman. 

Chairman  Pepper.  Mr.  Perito,  would  you  inquire? 

Mr.  Perito.  Dr.  DuPont,  as  you  know,  this  committee  is  particularly 
interested  in  an  evaluation  of  methadone  and  related  drug  abuse  pro- 
grams. One  of  the  matters  of  particular  interest  to  the  committee  is 
the  question  of  the  efficacy  of  methadone  maintenance  and  its  relation- 
ship to  the  decrease  in  crime  rate  or  illegal  activity  of  those  addicts 
under  such  treatment.  Have  you  any  statistical  studies  which  reflect 
findings  similar  to  those  which  Dr.  Gearing  presented  to  the  commit- 
tee this  morning  ? 

Dr.  DuPoNT.  Yes,  Mr.  Perito.  First  of  all,  the  District's  program 
is  not  simply  a  methadone  program.  It  is  a  multimodality  program  in 
which  some  people  are  taking  methadone  and  some  are  not.  Some 
patients  receive  methadone  maintenance ;  others  are  taking  it  for  de- 
toxification. 

I  will  answer  your  question,  but  I  want  to  begin  with  that  qualifica- 
tion because  it  relates  to  some  of  the  statistics  that  I  want  to  bring  up. 

Mr.  Perito.  Can  you  tell  us  how  many  addicts  are  presently  being 
treated  in  your  program  ? 

Dr.  DuPoNT.  The  current  number  is  3,106  as  of  last  Friday,  and  of 
that  number  1,760  are  on  methadone  maintenance,  633  methadone  de- 
toxification, 631  are  in  abstinence  programs.  An  additional  82  are  re- 
ceiving methadone  on  what  we  call  "methadone  hold"  which  means 
emerqfency  treatment  prior  to  complete  evaluation. 

Chairman  Pepper.  How  many  on  methadone  ? 


144 

Dr.  DuPoNT.  1,760  on  methadone  maintenance,  633  on  methadone 
detoxification,  82  on  methadone  hold,  which  is  an  emergency  short- 
term  treatment,  and  631  are  in  abstinence  programs,  that  is,  receiving 
no  methadone. 

Mr.  Perito.  Do  you  have  a  waiting  list,  Doctor  ? 

Dr.  DuPoNT.  We  don't  have  a  waiting  list  right  now.  We  have  in 
the  past,  and  we  are  moving  in  the  direction  of  having  a  waiting  list 
again.  We  found  that  a  waiting  list  discourages  many  people  from 
coming  into  the  program.  Only  about  30  percent  of  the  people  who 
sign  up  on  a  waiting  list  actually  show  up,  at  least  in  our  experience. 

Whenever  procedures  are  set  up  as  hurdles  for  people  to  get  over 
before  treatment,  act  to  discourage  the  use  of  the  treatment,  and  ac- 
cordingly limits  the  kind  of  people  who  will  go  over  these  hurdles 
to  get  in.  It  is  a  grave  step  to  take  to  build  up  barriers  of  any  kind  to 
get  into  narcotics  treatment. 

Narcotics  treatment  of  a  continuing  nature,  regardless  of  whether 
it  is  methadone  or  abstinence,  is  efficacious  in  reducing  not  onlv  heroin 
use  but  arrest  rates.  The  critical  question  that  needs  to  be  addressed  is 
the  issue  of  retention  in  program.  Some  programs  exaggerate  their 
fiarures  by  counting  patients  who  come  into  the  program  but  who.  for 
all  practical  purposes,  dropped  out  and  have  no  continuing  relation- 
ship. Those  patients  that  do  have  a  continuing  relationship  and  are 
participating  actively,  whether  methadone  or  not,  do  quite  well.  I 
don't  think  one  needs  to  feel  he  has  to  use  methadone. 

On  the  other  hand,  our  experience  is  that  for  most  criminal  heroin 
addicts  the  treatment  of  their  choice  and  the  one  that  seems  to  make 
the  most  sense  from  their  point  of  view  does  involve  methadone.  I 
think  heroin  addicts  need  to  have  choices  for  themselves  about  what 
kinds  of  treatment  they  are  going  to  get.  Our  program  at  NT  A  offers 
considerable  choice. 

Mr.  Perito.  Is  it  fair  to  say  that  your  programs  jjoals  are  similar  to 
the  goals  articulated  by  Dr.  Gearing  for  the  New  York  urograms? 

Dr.  DuPoNT.  Absolutely.  Manv  of  the  best  features  of  our  program 
have  been  taken  from  New  York,  including  our  basic  goals. 

Mr.  Perito.  Directing  your  attention  now  back  to  my  first  question, 
you  have  compiled  some  recent  statistics  pursuant  to  the  committee's 
request. 

Dr.  DtjPont.  Riffht.  Last  May  1^  we  drew  a  sample.  NTA  then  had 
1,060  patients  in  treatment.  We  did  a  random  sample  of  450  of  those 
patients.  Six  months  later,  56  percent  of  them  were  retained  in  the 
program. 

At  11  months,  the  figure  retained  had  fallen  to  40  percent.  So  that 
40  percent  of  the  people  in  the  program  last  May  15  were  still  in  the 
program  at  the  end  of  last  week. 

Now,  the  retention  rate  in  the  program  is  highly  related  to  the  use 
of  methadone.  I  don't  have  the  followup  data  to  11  months  on  the 
basis  of  treatment  modality,  but  at  6  months  the  results  were  quite 
striking.  We  found  that  patients  who  were  on  60  milligrams  or  more 
of  methadone  had  an  86-percent  retention  rate  at  6  months.  Of  the 
patients  who  elected  abstinence,  only  15  percent  remained  in  the  pro- 
gram for  6  months. 

There  is  a  very  high  dropout  rate  associated  with  abstinence  pro- 


145 

grams,  at  least  in  our  experience.  Those  who  did  stay  in  the  abstinence 
program  did  well.  That  needs  to  be  emphasized. 

Now,  about  the  arrest  rate :  Of  the  450  in  the  program  on  May  15, 
1970,  22.5  percent  were  arrested  in  the  course  of  the  following  11 
months. 

Of  the  186  who  stayed  in  the  program  the  entire  11  months,  or  until 
arrested,  a  total  of  25,  or  13  percent  were  arrested. 

Of  the  264  who  dropped  out  of  the  program,  75,  or  28  percent  were 
arrested. 

Now,  further  to  clarify  this  and  to  attempt  to  get  at  some  of  the 
harder  data  on  this,  Ave  found  that  not  all  of  the  450  people  in  the  study 
had  identifiable  records  of  detention  in  District  of  Columbia  jail. 
That  is,  we  couldn't  identify  District  of  Columbia  Department  of 
Corrections  numbers  on  all  the  patients. 

Mr.  Perito.  You  had  access  to  the  criminal  reference  reports  and 
rap  sheets,  I  assume  ? 

Dr.  DuPoxT.  We  had  access  to  the  rap  sheets  in  the  Department  of 
Corrections  so  that  if  a  person  is  detained  in  a  correctional  institution 
we  have  that  information. 

However,  if  he  is  arrested  and  released  before  going  on  to  incarcer- 
ation we  do  not  have  the  data.  This  has  happened  in  minor  offenses, 
such  as  traffic  cases  and  first  offenses,  but  it  is  not  common  with  addicts. 
However,  when  it  happens,  we  don't  have  the  information. 

There  is  a  law  in  the  District  of  Columbia  that  prohibits  the  police 
department  from  releasing  information  to  non-law-enforcement  agen- 
cies on  arrests.  We  are  looking  into  this  and  are  seeing  if  we  can't  get 
that  information.  It  won't  change  any  of  the  results,  because  we  use 
the  same  criteria  to  apply  to  those  who  are  in  the  program  and  those 
who  drop  out,  and  also  to  comparison  groups. 

So  although  the  total  number  would  change,  the  relative  percentages 
would  stay  the  same,  at  least  that  is  our  assumption. 

But  we  asked  this  question  another  way :  Of  those  people  who  have 
identifiable  rap  sheets,  how  many  were  arrested  over  11  months. 

We  found  that  19  percent  of  those  who  had  identifiable  rap  sheets 
and  who  stayed  in  the  program  were  arrested,  whereas,  99  percent  of 
the  145  who  dropped  out  and  w^ho  had  rap  sheets  were  arrested.  The 
relative  relationships  were  the  same ;  that  is,  the  people  who  dropped 
out  of  the  ])rogram  had  an  arrest  rate  over  the  period  of  11  months 
of  about  214  times  the  arrest  rate  of  those  who  stayed  in  the  program. 

Another  way  to  look  at  this  data  is  to  ask,  for  example,  about  the 
arrest  rate  for  a  comparison  group  or  similar  group.  The  most  simi- 
lar group  we  have  found  was  the  Department  of  Corrections  narcotics- 
involved  releases  prior  to  the  existence  of  the  Narcotics  Treatment 
Administration,  and  of  that  group  36  percent  were  arrested  in  6 
months. 

We  don't  have  the  figure  for  11  months,  but  it  would  be  over  50 
percent. 

Thus  for  those  who  stay  in  the  program  there  is  a  considerable 
reduction  in  the  arrest  rate  and  methadone  treatment  is  associated 
with  higher  retention  rates. 

On  the  other  hand,  I  am  not  here  to  say  that  a  simple  matter  of 
giving  a  person  methadone  is  a  panacea.  It  is  not  a  magic  method, 
as  some  have  thought,  to  absolutely  eliminate  criminal  activity.  But 


146 

there  are  dramatic  reductions  in  arrest.  There  are  some  other  studies 
of  a  more  impressionistic  nature  and  certainly  those  of  us  who  have 
clinical  experience  could  corroborate  this,  that  show  that  heroin  ad- 
dicts who  are  in  the  treatment  programs  do  in  a  dramatic  way  reduce 
their  heroin  use  and  that  much  of  their  criminal  behavior  was  driven 
by  their  need  to  get  heroin. 

On  the  other  hand,  let's  be  clear  that  we  are  talking  about  a  very 
disadvantaged  segment  of  the  population,  by  and  large,  a  group  for 
which  there  are  often  few  employment  opportunities,  a  group  with 
very  inadequate  education  and  a  group  which  has  developed  rather 
considerable  skills  in  hustling  and  illegal  activities. 

It  is  therefore,  hardly  surprising  to  find  that  this  simple  matter  of 
putting  a  person  in  a  treatment  program  does  not  in  itself  eliminate 
criminal  activity,  although  it  clearly  reduces  it. 

Mr.  Perito.  I  asked  Dr.  Gearing  about  her  knowledge  of  efficacy 
studies  of  drug-free  programs,  the  value  of  detached  analytical  studies, 
and  similar  questions  about  the  crime  reduction.  Do  you  know  of  any 
such  studies  in  the  drug-free  programs  across  the  Nation  so  that  this 
committee  can  compare  those  results  with  the  results  of  methadone 
and  related  drug  programs? 

Dr.  DuPoNT.  I  think  drug-free  programs  have  tended  to  get  in- 
volved unnecessarily  in  rhetoric  and  politics. 

They  tend  to  get  more  involved  in  this  and  have  a  hard  time  deal- 
ing with  failures.  So  they  are  quite  resistant  in  general  to  doing  the 
kind  of  studies  that  Dr.  Gearing  has  done  and  the  kind  of  study  that 
T  reported  here  which,  after  all,  reports  something  less  than  complete 
success. 

Abstinence  programs  have  a  hard  time  dealing  with  their  very  high 
dropout  rates. 

I  don't  know  of  any  published  evidence  of  the  efficacy  of  any  drug- 
free  programs  that  is  comparable  in  any  way  with  the  kind  of  data 
that  Dr.  Gearing  has  presented. 

On  the  other  hand,  it  is  my  impression  from  visiting  drug-free 
programs  that  they  have  considerable  merit.  The  problem  is  that  they 
are  not  acceptable  to  many  heroin  addicts.  And  many  people  who  do 
start  there,  do  drop  out.  So  I  think  that  any  city  which  is  thinking 
about  programing  for  heroin  addiction  treatment,  needs  to  include 
abstinence  or  drug-free  programs,  but  it  needs  some  perspective  in 
terms  of  their  efficaciousness  and  their  acceptability  to  the  heroin 
addicts. 

I  guess  I  could  have  answered  that  question  by  simply  saying  "No." 

Mr.  Perito.  Doctor,  at  the  present  time,  what  is  vour  appropriation? 

Dr.  DuPoNT.  The  current  appropriation  for  the  Narcotics  Treat- 
ment Administration  is  $2.2  million  with  an  additional  $2.9  million 
available  to  us  through  Federal  grants. 

Mr.  Perito.  In  addition  to  NTA's  treatment  programs,  are  you  pres- 
ently carrying  on  any  independent  research  in  the  opiate  area  ? 

Dr.  DuPoNT.  Well,  our  research  is  primarily  related  to  two  ques- 
tions, really : 

One  is  trying  to  do  some  monitoring  of  the  epidemic  of  addiction  in 
the  District  of  Columbia,  and  the  other  is  evaluating  the  performance 
of  our  programs.  We  don't  do  any  basic  research  into  chemical  alter- 
natives to  methadone,  for  example,  or  many  other  kinds  of  research. 


147 

Mr.  Perito.  Doctor,  under  the  IND  concept,  as  I  understand  it, 
your  program  is  not  specifically  designated  as  a  methadone  mainte- 
nance program  ^ 

Dr.  DuPoNT.  Well,  the  IND  procedure  does  not  specify  what  main- 
tenance is,  and  this  has  been  a  very  serious  handicap  in  the  District 
of  Columbia  in  terms  of  trying  to  come  to  grips  with  the  private  phy- 
sicians and  others  who  are  using  methadone  in  ways  that  many  of  us 
feel  are  not  responsible.  There  are  regulations  associated  with  the 
Food  and  Drug  Administration  that  deal  with  methadone  mainte- 
nance, but  since  they  don't  define  "maintenance,"  it  is  quite  possible 
for  people  to  talk  about  long-term  or  even  endless  detoxification  pro- 
grams. 

They  talk  about  20-year  detoxification  programs.  In  other  words, 
there  is  no  point  at  which  detoxification  becomes  a  maintenance.  It 
is  a  matter  of  anyone's  semantics. 

NTA  does  have  an  application  with  the  Food  and  Drug  Adminis- 
tration and  we  have  the  distinction  of  being  one  of  the  few  programs 
to  be  audited  by  the  Bureau  of  Narcotics  and  Dangerous  Drugs.  Five 
agents  went  over  our  procedures  about  2  weeks  ago,  and  this  was 
very  helpful. 

But  in  general  the  Food  and  Drug  Administration  and  the  Bureau 
of  Narcotics  and  Dangerous  Drugs  make  no  attempt  in  assessing  com- 
pliance, either  with  their  regulations  or  IND  protocol  that  was  filed 
with  them. 

Mr.  Perito.  Doctor,  we  have  heard  testimony  from  several  wit- 
nesses that  it  was  their  considered  judgment  that  a  private  physician 
could  not  properly  dispense  methadone  within  an  ordinary  office  be- 
cause such  physician  is  not  able  to  offer  the  proper  and  necessary  an- 
cillary and  supportive  services.  Do  you  maintain  a  similar  opinion? 

Dr.  DuPoNT.  Well,  I  asrain  find  myself  really  following  in  the 
footsteps,  to  some  extent,  of  the  work  that  has  been  done  in  New  York 
City  and  what  Dr.  Gearing  said  today. 

lit  is  obvious  in  dealing  with  a  widespread  epidemic  that  has  clear 
medical  dimensions  and  where  medical  skills  are  valuable,  that  it 
doesn't  make  sense  to  entirely  write  off  the  private  health  care  sector 
and  trv  to  create  an  entirelv  Government-run  clinic  system  to  deal 
with  all  the  problems  of  all  the  people  who  are  currently  heroin 
addicts. 

So  I  think  the  challensre  is  to  find  ways  to  make  use  of  the  private 
sector  in  a  constructive  way. 

I  think  probably  a  good  way  to  start  is  to  have  private  phvsicians 
associate  themselves  with  ongoing  structured  programs  and  then  to 
pick  up  stabilized  to  successfully  adjusted  maintenance  patients  to 
follow  privately. 

Therefore,  after  a  person  has  been  in  a  methadone  program  and 
demonstrated  his  stabilitv  for  6  months  or  a  vear,  then  he  would  be 
transferred  to  a  private  physician  who  would  handle  no  more  than 
10  or  20  heroin  addict  patients  as  part  of  his  regular  practice. 

In  this  way  we  get  away  from  part  of  the  financial  gain  of  private 
phvsicians  merelv  selling  prescriptions. 

We  don't  build  Government  clinics  to  treat  all  diabetics.  Most  dia- 
betics get  private  care.  Stabilized  heroin  addicts  can  also  move  to  the 
private  sector. 


148 

Health  insurance  coverage  for  methadone  maintenance  is  important 
once  the  person  is  stabilized.  The  private  doctor  then  has  the  option, 
if  that  person  breaks  down,  of  returnino;  him  to  the  public  clinic  from 
which  he  came  for  more  extensive  work. 

The  private  physician  doesn't  have  the  capability  of  control  of 
methadone  that  is  needed  in  the  induction  phases  of  methadone  treat- 
ment. This  involves  more  than  just  ancillary  services.  Private  doctors 
have  made  their  greatest  errors  by  p:iving  unstabilized  patients  1  or  2 
weeks'  supply  of  methadone  right  at  the  beginnino;  so  that  a  patient 
takes  out  a  bottle  or  prescription  of  methadone  which  he  takes  in  an 
unsupervised  way. 

I  think  the  dangers  to  the  public  from  such  practices  are  very  great 
and  ought  to  be  avoided. 

Mr.  Pertto.  Chairman  Peoper  mentioned  tlie  situation  relating  to 
recent  deaths.  Do  you  anticipate,  with  tlie  expansion  of  methadone 
programs,  that  death  is  a  natural  incident,  that  there  will  be  three  or 
four  deaths  as  a  result  of  the  inevitable  distribution  process  of  your 
program,  either  because  of  misuse  or  wrongful  distribution  or  a  situa- 
tion where  a  nontolerant  person  accidentally  ingests  methadone  in- 
tended for  an  NT  A  addift  ? 

Dr.  DuPoNT.  "Well,  I  think  that  there  will  be  deaths,  and  there  have 
been. 

On  the  other  hand,  I  would  certainly  not  take  a  fatalistic  view  that 
these  are  unpreventable  and  we  just  pass  them  off  and  go  to  the  next 
patient. 

I  think  we  need  to  take  these  methadone-related  deaths  very  seri- 
ously and  to  do  everything  in  our  power  to  try  to  reduce  the  likelihood 
of  that  kind  of  event  occurring.  For  this  reason  NTA  issues  take-home 
methadone  in  locked  boxes  and  child-proof  bottles.  We  have  rather 
elaborate  forms  that  the  patient  signs. 

On  the  other  hand,  I  think  it  is  a  very  serious  public  relations  prob- 
lem. All  of  the  methadone  deaths  that  are  occurring  are  being  charged 
either  explicitly  or  implicitly  to  the  NTA  programs,  and  this  is  far 
from  being  true. 

In  the  last  9  months  in  the  District  we  have  been  able  to  uncover 
23  deaths  that  involved  methadone,  either  alone  or  with  other  drugs. 

In  only  five  of  those  deaths  was  there  any  relationship  to  the  NTA 
program.  Thus,  18  of  them  had  nothing  to  do  with  the  program. 

But  there  were  five  deaths  related  to  NTA  and  we  do  everything 
we  can  to  prevent  the  likelihood  of  that  occurring  again.  But  in  a 
situation  where  only  about  20  percent  of  the  deaths  are  associated  with 
the  NTA  program,  we  suffer  the  criticism  for  all. 

Chairman  Pepper.  Dr.  DuPont,  we  have  had  a  quorum  call  on  the 
floor  of  the  House.  If  you  will  please  suspend  and  await  our  return, 
we  will  go  over  and  answer  the  quorum  and  be  right  back. 

We  will  take  a  temporary  recess  until  we  can  get  back,  to  answer 
the  call  on  the  floor. 

(A  brief  recess  was  taken.) 

Chairman  Pepper.  The  commitee  will  resume  session,  please. 

Dr.  DuPont  is  on  the  stand. 

Mr.  Perito  was  inquiring  of  Dr.  DuPont. 

Mr.  Perito.  Dr.  DuPont,  have  had  occasion  to  administer  cycla- 
zocine  or  naloxone  to  any  of  the  addicts  in  your  program  ? 


149 

Dr.  DuPoNT.  No ;  we  haven't.  The  only  drug  we  have  used  is  metha- 
done. 

Mr.  Perito.  You  are  probably  aware  of  certain  testimony  that  has 
been  given  previously  to  congressional  committees  by  Dr.  Yolles  who 
has  stated  that  cyclazocine  and  naloxone  and  antagonistic  drugs  are 
one  of  the  most  promising  areas  of  narcotic  research.  Do  you  have  an 
opinion,  based  on  your  experience,  with  antagonistic  drugs? 

Dr.  DuPoNT.  I  think  you  are  going  to  hear  from  Dr.  Jaffe,  who 
is  one  of  the  foremost  experts  on  the  subject. 

As  a  clinician  and  an  administrator,  there  are  problems  with  the 
antagonistic  drugs.  Put  simply,  they  are  not  acceptable  to  patients. 
Nowhere  in  the  country,  to  my  knowledge,  has  there  been  any  large 
scale  use  of  these  drugs.  The  real  issue — at  least  one  of  the  initial  prob- 
lems— is  that  the  heroin  addicts  don't  find  the  antagonists  helpful  to 
them.  Most  patients  don't,  although  there  are  a  few  who  do. 

The  other  problem  is  that  the  antagonists  are  presented  to  the  pub- 
lic as  if  they  were  somehow  more  benign  than  methadone,  for  example, 
or  were  somehow  to  be  treated  more  casually. 

I  think  this  is  a  mistake,  and  I  think  that  the  antagonists  that  we 
know  of  so  far  are  like  methadone  in  that  they  are  only  useful  so  long 
as  they  are  taken  regularly  and  remain  in  the  body ;  that  is,  they  don't 
immunize  the  person  against  anything,  patients  have  to  go  right  on 
taking  cyclazocine  or  naloxone  and  we  know  far  less  about  the  long- 
term  effects  of  these  drugs  than  we  know  about  methadone. 

Mr.  Petiro.  Two  final  questions,  Dr.  DuPont. 

When  you  testified  before  our  committee  in  October  1970  you  stated 
that  to  the  best  of  your  knowledge  the  addict  population  in  AVashing- 
ton  was  10,400.  Subsequently  you  reevaluated  your  estimate  and  you 
have  stated,  to  the  best  of  my  knowledge,  that  the  addict  population 
is,  in  fact,  18,000.  Would  that  be  your  estimate  today,  18,000  ? 

Dr.  DuPoNT.  Well,  our  current  best  estimate  is  16,800. 1  am  not  pre- 
pared to  change  that  estimate  yet,  although  it  may  be  that  the  addict 
population  is  not  growing  any  more,  as  it  was  in  previous  years.  We 
don't  have  good  enough  measures,  really,  of  changes  in  the  addict 
population. 

But  the  death  rate  has  not  been  going  up  in  the  District  over  the 
course  of  the  last  9  months.  If  anything,  it  has  fallen  slightly  during 
this  period  of  time. 

So  I  use  16,800  as  a  ballpark  estimate.  The  only  fact  that  is  really 
relevant  is  that  there  are  still  very  many  untreated  heroin  addicts  in 
the  Washington  community  who  are  suitable  for  and  interested  in 
treatment. 

We  had  occasion  5  weeks  ago  to  open  up  a  new  clinic.  It  was  the 
first  new  clinic  NTA  had  opened  in  many  months.  This  clinic  was 
swamped  with  patients,  going  from  zero  to  200  patients  in  the  course 
of  6  weeks. 

Even  though  we  are  providing  treatment  for  3,000  patients  we  can 
recruit  200  new  addicts  by  opening  a  clinic  for  just  6  weeks.  This  is  a 
very  startling  demonstration  that  when  clinics  are  opened  they  attract 
patients.  I  think  the  only  relevant  fact  is  that  there  are  thousands  of 
untreated  heroin  addicts  in  the  District  of  Columbia  today. 

Mr.  Perito.  How  many  addicts  are  presently  being  treated  in  the 
District  either  under  the  auspices  of  NTA  or  some  other  program  op- 
erating and  funded  within  the  District? 


150 

Dr.  DtjPont.  Well,  there  are  no  other  proarrams  that  have  anything; 
like  comparable  numbers.  I  would  pav  that  usingr  our  definition  there 
are  no  more  than  500  other  heroin  addicts  who  are  beinff  treated  in  all 
the  Drop-rams  in  the  citv.  inclndina:  the  abstinence  programs. 

Including  the  detoxification  programs  and  the  private  physicians, 
it  mav  be  that  there  are  as  manv  as  a  thousand  more  patients  in  all. 
I  can't  imaarine  the  total  beino-  hisfher. 

Chairman  Pepper.  Dr.  DnPont,  you  told  u«  that  approximatelv  half 
of  the  peonle  who  were  in  jail  here  in  the  District  were  found  to  be 
heroin  addicts. 

Have  those  figures  been  carried  forward  by  the  police  department  at 
the  present  time? 

Dr.  DuPoNT.  Yes:  we  repeated  this  study  in  January  1971,  and 
have  not  finished  analvzinof  it.  I  don't  have  the  full  breakdown  yet. 
But  it  was  very  sicrnificant  that  there  wasn't  an  obvious  reduction  in 
the  percent.  The  figure  is  still  about  50  percent. 

One  thing:  that  was  quite  dramatic,  however,  was  that  the  percent 
of  druff  arrests  had  increased  dramatically.  Whereas  when  the  initial 
study  was  done  in  August  1969,  10  percent  of  the  total  of  all  people 
coming  into  the  jail  were  on  druq-  charges.  By  January  1971,  the 
figure  had  risen  to  22  percent  of  all  jail  intake. 

This  reflected  the  fact  that  far  more  purely  drug  charges  were  being 
made  by  the  police. 

Chairman  Pepper.  Has  there  been  any  studv  made  of  heroin  addic- 
tion among  people  arrested  for  burglary,  offenses  against  property, 
and  muggings  on  the  streets? 

Dr.  DuPoNT.  Yes.  We  found  that  the  addicts  were  slightly  less 
likely  to  commit  crimes  aarainst  people  than  the  nonaddicts  coming 
into  the  jail,  but  that  the  differences  were  not  statistically  significant. 

For  instance,  more  than  half  of  the  criminal  homicides  were  com- 
mitted by  addicts. 

Chairman  Pepper.  More  than  half  of  the  homicides  were  committed 
by  heroin  addicts? 

Dr.  DuPoNT.  Right.  So  anybody  who  is  reassured  by  thinking  that 
heroin-addiction-related  crime  is  confined  to  shoplifting,  prostitution, 
and  drug  sales  is  sadly  mistaken. 

Chairman  Pepper.  I  am  glad  to  get  that  clarified.  I  thought  it  was 
generallv  assumed  that  heroin  addicts  were  not  very  dangerous.  They 
were  satisfied,  had  a  sensation  of  feeling  good,  but  you  said  half  of 
the  criminal  homicides  are  committed  by  addicts  ? 

Dr.  DuPoNT.  That  is  right.  But  this  must  be  put  in  perspective. 

Most  serious  crimes,  the  FBI  index  crimes,  are  property  crimes.  The 
last  time  I  looked  at  the  list,  86  percent  of  all  the  serious  crimes  in 
America  were  so-called  nonperson  or  property  crimes.  So  that  addicts 
are  like  other  criminals,  other  criminal  behavior  of  other  people  in 
that  the  primary  crimes  addicts  commit  are  property  crimes. 

On  the  other  hand,  if  you  turn  the  question  around  and  you  ask  of 
the  person  crimes,  of  the  robberies,  of  the  muggings,  of  the  homicides, 
itself,  what  percentage  of  those  crimes  are  committed  by  addicts  sup- 
porting their  habits,  the  answer  is  about  one-half.  This  is  a  very 
serious  and  very  important  finding. 

Chairman  Pepper.  Half  of  the  crimes  against  property  and  against 
person  ? 


151 

Dr.  DuPoNT.  It  is  about  equal.  In  other  words,  addicts  commit 
about  one-half  of  the  person  crimes  and  about  one-half  of  the  property 
crimes. 

Chairman  Pepper.  So  that  the  heroin  addiction,  then,  has  a  very 
direct  relationship  to  crime  ? 

Dr.  DuPoNT.  Absolutely,  including  crimes  against  people. 

Now,  again  this  is  not  a  drug  effect.  The  heroin  addict  who  is  high 
is  not  a  person  inclined  to  commit  crimes  because  the  drug  tranquilizes 
the  person.  But  he  commits  crimes  to  secure  money  to  buy  heroin,  and 
this  need  leads  to  desperation  on  the  part  of  many  addicts  and  they 
act  in  ways  that  are  extremely  dangerous  to  themselves  and  others. 

Chairman  Pepper.  Well,  now,  you  gave  us  evidence,  as  I  recall,  last 
year,  when  you  appeared  before  our  committee,  that  in  your  opinion 
the  average  addict  in  the  street,  in  the  District  of  Columbia  stole — or 
had  to  get  illegal  possession  by  offenses  against  the  person  or  other- 
Avise — about  $50,000  worth  of  property  a  year  in  order  to  sustain  his 
heroin  addiction.  Is  that  still  your  general  opinion  ? 

Dr.  DuPoNT.  Yes.  That  kind  of  evidence  comes  from  asking  addicts 
about  the  size  of  their  habits  and  then  making  some  assumptions 
about  the  ways  they  get  their  money.  For  example,  if  a  person  says  he 
needs  $40  a  day  to  buy  his  heroin,  you  would  figure,  if  he  is  involved  in 
stealing  property,  that  he  has  to  steal  it  at  some  discount  so  the  total 
value  of  the  property  stolen  is  some  figure  in  excess  of  the  $40. 

On  the  other  hand,  there  have  been  some  studies,  since  I  testified 
before  you  last,  that  would  suggest  that  the  total  amount  of  property 
crimes  in  the  District  of  Columbia,  at  least  as  reported  and  estimated, 
is  not  large  enough  to  support  that  assumption.  So  that  this  technique 
may  overstate  the  actual  criminal  activity  related  to  heroin  addiction. 

On  the  other  hand,  we  don't  really  know  how  much  unreported 
crime  there  is.  We  are  also  in  a  swampy  area  when  we  estimate  how 
many  addicts  there  are.  The  only  thing  we  need  to  know  however  is 
that  there  is  a  tremendous  amount  of  criminal  activity  associated  with 
drug  addicts.  In  the  District  of  Columbia  alone,  $200  million  a  year 
is  probably  a  low  estimate. 

Chairman  Pepper.  What  do  you  estimate  to  be  the  average  cost  of 
heroin  addiction  a  day  ? 

Dr.  DuPoNT.  Well,  $40  is  the  figure  found. 

Chairman  Pepper.  In  other  words,  he  has  to  get  enough  property 
in  one  way  or  another  to  net  $40  a  day  ? 

Dr.  DuPoxT.  $40  a  day.  But  the  addict  will  put  into  his  arm  as 
much  as  he  can  get.  The  limit  is  not  the  physiology  having  to  do  with 
the  drug,  but  his  ability  to  get  the  money.  Some  days  he  is  not  as  able 
as  others  so  his  habit  fluctuates. 

Chairman  Pepper.  Mr.  Blommer. 

Mr.  Blommer.  Thank  you,  Mr.  Chairman. 

Doctor,  we  are  going  to  have  Mr.  Horan,  the  commonwealth  attor- 
ney from  Fairfax  County,  testify  here  tomorrow,  and  he  believes  there 
is  a  methadone  epidemic. 

Dr.  DuPoNT.  I  believe  there  is  a  serious  problem  with  methadone 
in  illegal  channels  in  this  city. 

Mr.  Blommer.  Do  you  accept  methadone  addicts  in  your  program  ? 

Dr.  DuPoNT.  You  mean  people  who  come  to  us  and  say  they  have  a 
methadone  habit  from  somewhere  else  and  say  they  want  to  come  into 
the  program ;  sure. 


152 

Mr.  Blommer.  You  would  agree  there  is  a  black  market  in  meth- 
adone ? 
Mr.  DuPoNT.  Yes. 

Mr.  Blommer.  And  there  will  come  a  time — I  assume  you  are  al- 
ready thinking  of  it — when  you  have  hard-core  methadone  addicts 
that  may  have  become  addicts  from  unscrupulous  doctors,  from  the 
black  market,  or  whatever,  but  now  we  have  hard-core  methadone 
addicts. 

Dr.  DuPoNT.  Most  of  those  people  are  using  heroin,  also.  It  will 
depend  on  the  availability.  I  don't  think  you  are  going  to  find  people 
who  are  shooting  methadone,  for  example,  who  are  not  also  shooting 
heroin.  Usually  they  will  go  back  and  forth,  and  use  whatever  is 
more  available. 

Mr.  Blommer.  Would  you  believe  it  would  be  efficacious  to  take 
those  people  in  your  program  ? 

Dr.  DuPoNT.  Yes.  They  are  j  ust  like  heroin  addicts. 
Mr.  Blommer.  Doctor,  I  know  we  have  a  disagreement  on  statistics 
and  what  they  mean.  I  do  have  a  sheet  here  that  I  believe  we  got 
from  your  office  that  shows  in  the  last  6  months  in  1970,  60  people 
that  were  autopsied  by  the  D.C.  coroner  had  narcotics  in  their  bodies. 
As  I  read  it,  10  of  the  60  died  of  gunshot  wounds,  13  of  the  dead 
people  had  only  methadone  in  their  body,  one  had  cocaine,  and  one 
had  Talwin.  Therefore,  15  of  the  50  remaining  after  we  take  away 
the  gunshot  deaths  had  no  heroin  in  their  bodies.  That  leaves  us 
with  35  heroin-related  deaths.  Could  you,  using  whatever  analysis 
or  formula  you  want,  make  a  judgment  on  how  many  heroin  addicts 
there  are  in  the  District  of  Columbia  ^ 

Dr.  DuPoNT.  I  am  having  a  little  trouble  following  your  assump- 
tions. You  are  making  the  assumption  that  the  methadone  addict  is 
different  from  the  heroin  addict  when  he  is  pursuing  addiction  on 
the  street.  In  other  words,  methadone  will  compete  with  heroin  and 
produce  the  same  effects  when  injected. 

Injected  methadone  produces  a  high  like  herom.  It  strikes  me  as 
sortof  a  question  of  semantics. 

You  could  call  them  opiate  addicts  and  lump  them  together  and 
talk  about  the  frequency.  .  i  j  i     -i     j 

For  example,  if  it  were  more  available,  morphnie  would  be  the  drug 
of  choice.  Today  heroin  is  the  main  drug  in  the  black  market,  but 
other  opiates  would  work  just  fine.  , 

Mr.  Blommer.  Doctor,  what  I  am  suggesting  is  that  it  and  wtien 
we  clear  up  the  heroin  problem  that  we  might  then  be  dealing  with 
a  methadone  problem.  .  , 

Dr  DuPoNT.  I  don't  call  that  "clear."  We  now  have  an  opiate 
addiction  problem  that  is  very  serious,  and  if  we  switch  from  one 
drug  to  the  other,  and  have  all  the  same  consequences,  we  have  gained 

''''Mr!'BL0MMER.  But  the  point  is,  though,  Doctor,  no  matter  who  is 
giving  the  drugs  out,  there  will  be  people  who  will  be  methadone 
addicts  and  people  who  are  heroin  addicts. 

Mv  question  is:  Don't  you  feel  that  there  is  a  great  danger  that 
the  people  becoming  metliadone  addicts  will  then  ] ust  come  to  vou 
instead  of  to  the  street  pusher  that  they  used  to  go  to  for  herom? 

Dr.  DuPoNT.  Well,  come  to  me  for  what  ? 

Mr.  Blommer.  For  their  drugs,  for  their  methadone. 


153 

Dr.  DuPoNT.  To  do  what  ? 

Mr.  Blommee.  To  satisfy  their  craving,  assuming  they  are  metha- 
done addicts,  to  satisfy  their  craving  for  methadone. 

Dr.  DuPoxT.  And  then  stay  in  the  program  and  pursue  the  course 
we  are  interested  in  in  the  program.  So  what  is  the  problem? 

Mr.  Blommer.  The  problem  is  you  are  aiding  them  in  being  addicts. 

Dr.  DuPoNT.  I  don't  see  how  we  are  aiding  them  in  being  addicts. 
They  were  addicts  before  they  ever  got  there. 

Mr.  Blommer.  Doctor,  is  all  the  methadone  dispensed  by  your  clinic 
to  the  1,700  people  you  are  maintaining,  is  all  that  consumed  in  front 
of  you  ? 

Dr.  DuPoNT.  No;  the  patients  who  are  stabilized  in  the  program 
have  take-home  privileges  and  they  take  the  methadone  out  with  them. 

Mr.  Blommer.  Don't  you  see  a  problem  ?  Couldn't  those  people  sell 
to  the  black  market  and  then  take  heroin,  for  instance  ? 

Dr.  DuPoxT.  Sure ;  but  I  think  you  are  looking  at  a  little  thing  and 
overlooking  a  big  thing.  Where  do  you  think  the  methadone  is  coming 
from  that  is  causing  Mr.  Koran's  and  other  people's  problems  in  Fair- 
fax County  ?  It  is  not  coming  from  our  program.  He  knows  that. 

He  has  said  as  much.  Are  you  saying  there  should  be  no  take-home 
medication?  What  we  need  is  widespread  availability  of  good  treat- 
ment programs,  whether  they  are  in  Virginia  or  the  District.  If  you 
did  that  you  would  undercut  tremendously  the  black  market  in  heroin. 
You  would  undercut  tremendously  the  death  rates  that  we  are  seeing, 
and  there  would  be  a  tremendous  social  gain  associated  with  that.  The 
need  for  good  treatment  is  the  big  thing.  Our  take-home  procedures 
are  the  little  thing.  We  also  need  to  do  something  about  the  uncon- 
trolled, unsupervised  dispensing  of  methadone  in  the  metropolitan 
area.  Do  you  agree  with  my  statement  ? 

Mr.  Blommer.  Well,  to  some  degree;  but  you  seem  to  premise  that 
on  the  fact  that  the  black  market  now  comes  from  unscrupulous  doc- 
tors. 

Dr.  DuPoNT.  And  perhaps  other  sources  that  I  don't  know  about, 
but  I  am  quite  sure  that  it  is  not  coming  from  our  NTA  program. 

Mr.  Blommer.  Do  you  have  an  opinion  on  how  easy  it  is  to  manu- 
facture methadone  ? 

Dr.  DuPoxT.  I  talked  to  Mr.  Ingersoll,  Director  of  the  Bureau  of 
Narcotics  and  Dangerous  Drugs,  and  he  said  as  far  as  he  knew  there 
was  no  illegal  manufacture  of  methadone. 

Mr.  Blommer.  My  question  is :  Do  you  know  how  easy  it  is  to  manu- 
facture it  illicitly  ? 

Dr.  DuPox'^T.  I  don't  know  how  easy  it  is. 

Mr.  Blommer.  Did  Mr.  Ingersoll  tell  you  about  the  laboratory? 

Mr.  DuPoxT.  In  Tupelo,  Miss.  They  broke  that  one  2  years  ago. 

Mr.  Blommer.  And  that  man  had  made  50  kilos  of  methadone. 

Dr.  DuPoxT.  Yes ;  maybe  it  will  be  happening  again.  If  your  argu- 
ment is  methadone  is  not  a  panacea  and  needs  to  be  thought  of  as  hav- 
ing a  serious  abuse  potential,  I  agree  with  you. 

Mr.  Blommer.  My  argument  is  you  should  have  far  stricter  controls 
than  apparently  you  have. 

Dr.  DuPoxT.  There  is  no  evidence  of  our  methadone  being  a  prob- 
lem in  terms  of  control.  We  have  questioned  the  police  to  find  if  they 
find  it  in  illicit  channels.  Our  methadone  is  clearly  labeled.  The  police 
haven't  brought  even  one  bottle  that  they  have  found  of  our  metha- 

60-296  O— 71— pt.  1—^11 


154 

done.  Where  is  the  evidence  ?  Nobody  in  Fairfax  County  has  died  be- 
cause of  our  methadone.  What  is  the  problem  we  are  addressing? 

Mr.  Blommer.  Mr.  Horan,  I  think,  will  address  himself  to  that 
problem.  I  don't  feel  I  should  speak  for  him. 

That  is  all  the  questions  I  have. 

Chairman  Pepper.  Mr.  Mann. 

Mr.  Mann.  Your  methadone  in  the  program  is  administered  in  a 
wav  to  bring  about  stabilization,  which  means  they  don't  get  high  off 
of  it? 

Dr.  DuPoNT.  Eight. 

Mr.  Mann.  That  w^ould  make  it  different  from  the  street  addict  of 
even  methadone  ? 

Dr.  DuPoNT.  Right. 

Mr.  Mann.  You  mentioned  there  were  a  wide  variety  of  choices  of 
programs  under  yours.  I  don't  see  but  two,  the  methadone  maintenance 
and  abstinence  programs.  What  else  is  there  ? 

Dr.  DuPoNT.  To  give  you  an  example  of  the  diversity  of  the  pro- 
grams, we  have  halfway  houses  in  which  people  can  live  in  where  they 
can  in  some  cases  take  methadone  and  others  remain  abstinent. 

We  have  65  beds  in  a  hospital  unit  for  detoxification,  primarily  for 
young  people.  They  have  programs  entirely  abstinent  and  these  are 
used  a  good  deal.  We  have  people  taking  it  in  decreased  dosages,  lead- 
ing to  abstinence  and  others  maintained  on  it. 

For  example,  in  the  city  we  cooperate  with  Colonel  Hassan  and  the 
Black  Man's  Development  Center.  In  the  Black  Man's  Development 
Center  patients  go  through  a  different  experience  entirely  and  are 
educated  in  citizenship  training,  residential  treatment,  and  decreasing 
doses  of  methadone.  That  is  a  very  different  kind  of  treatment  experi- 
ence than  goes  on  in  most  of  the  rest  of  our  programs. 

Another  program,  Step-One,  run  by  ex-offenders  known  as  Bona- 
bond.  Inc.,  is  a  halfway  house  and  outpatient  clinic  that  uses  no 
methadone. 

A  person  can  move  freely  between  any  of  these  options. 

Another  program.  Guide,  D.C.,  uses  psychologists  and  social  work- 
ers, in  family  and  individual  therapy  of  patients,  and  for  those  who 
find  that  useful,  they  can  go  to  the  program. 

So  there  is  quite  a  variety  of  treatment  programs,  perhaps  not  com- 
plete, but  quite  a  variety. 

Mr.  Mann.  Getting  back  to  the  chairman's  reaction  to  your  state- 
ment of  crimes  of  personal  violence.  I  was  interested  in  your  state- 
ment that  these  crimes  of  personal  violence  were  not  motivated  by  the 
drug  effect,  but  were  still  motivated  by  the  acquisition  of  property, 
of  funds  to  sustain  their  habits. 

Dr.  DuPont.  Right. 

Mr.  Mann.  Have  you  made  any  effort  to  distinguish  those  property- 
related  crimes,  even  though  they  result  in  personal  violence,  from 
crimes  of  passion  resulting  in  personal  violence  ? 

If  you  were  to  take  homicides  and  divide  them  in  half  you  would 
find  that  half  passion  and  half  property  ? 

Dr.  DuPoNT.  Right.  I  haven't  looked  at  that,  but  that  is  a  good 
question.  I  will  look  into  that  and  maybe  I  can  supply  something  for 
the  record  on  those  crimes  committed  in  our  previous  study. 

Mr.  Mann.  Very  good. 

Thank  you,  Mr.  Chairman. 

(The  information  referred  to  above  follows:) 


155 


100  addicts 

125  nonaddicts 

Offense  with  which  charged 

Profit            Passion 

Profit 

Passion 

Larceny 

Robbery 

Burglary 

21 

10 

6 

11  ... 
15  .... 

8  ... 

3  ... 

1  ... 

Stolen  property 

3 

Housebreaking 

Offense/family 

1 

Assault 

5  .... 
3  .... 

9 

Homocide 

1 

Assault/deadly  wea pon 

3 

A  rmed  robbery 

1 

2  ... 

1  .... 

3  ... 

2  .... 

Bank  robbery 

Forgery 

Fraud 

Manslaughter 

2 

3 

2 

2 

Private  orooertv        

4 

Total 

Total  (percent)     

48 

48 

8 
8 

46 
37 

20 
16 

Note.— Table  Is  a  result  of  study  conducted  by  the  Narcotics  Treatment  Administration  at  D.C.  Jail  between  Aug.  11  and 
Sept.  29, 1969,  on  an  accidental  sampling  of  225  Inmates. 

Chairman  Pepper.  Mr.  Wiggins. 

Mr.  Wiggins.  Dr.  DuPont,  I  am  still  a  little  bit  confused  on  the 
effect  of  methadone  on  the  human  body.  When  it  is  taken  by  a  patient 
in  your  program,  what  effect  does  it  have  on  that  patient  ? 

Dr.  DuPoNT.  Well,  the  regular  effect  is  that  the  person  comes  into 
the  program  and  he  has  an  opiate  habit  which  is  in  almost  all  cases, 
at  least  as  far  as  I  have  ever  seen  any  data,  a  heroin  habit. 

When  he  comes  he  wants  some  help  with  that,  and  he  will  take  an 
initial  dose  of  methadone  of  around  30  to  50  milligrams.  Now,  when 
he  takes  that  he  has  a  suppression  of  the  withdrawal  of  symptoms 
that  he  usually  experiences  and  he  feels  relatively  normal. 

Now,  the  patient  has  choices  at  that  point,  and  he  can  either  go  on 
decreasing  doses  leading  to  abstinence,  taking  anywhere  from  a  few 
days  to  a  few  months ;  or  he  can  choose  a  maintenance  schedule  in  which 
his  dose  goes  up  to  about  100  milligrams  and  he  stabilizes  at  that  point 
until  he  feels  it  makes  sense  to  try  detoxification  and  comes  down 
again. 

Depending  on  the  amount  of  the  drug,  and  if  there  is  a  little  bit 
more  given  than  is  needed  just  to  suppress  withdrawal  symptoms,  the 
person  might  feel  a  little  drowsy,  a  little  euphoria. 

He  would  also,  in  many  cases,  experience  constipation.  Some  people 
will  also  experience  excessive  sweating.  Those  are  the  primary  effects. 

In  addition,  while  the  person  is  on  increasing  doses  or  beginning 
treatment,  some  men  have  a  transient  impotence,  probably  associated 
with  the  anesthetic  effect  of  the  drug.  The  mechanism  is  not  clear. 

Once  he  is  stabilized,  the  only  effect  that  most  patients  experience 
is  the  constipation  and  excessive  sweating.  In  other  words,  there  is 
tolerance  to  the  other  effects,  except  suppression  of  the  opiate  drug 
craving  and  the  blocking  of  the  euphoric  effects  of  heroin. 

Mr.  Wiggins.  Is  there  any  benefit  of  feeling  good  by  going  out  and 
getting  more  methadone  if  you  are  on  a  diet  of  100  milligrams  ? 

Dr.  DuPoNT.  No.  Once  on  100  milligrams  there  is  no  effect  either 
orally  or  injected.  Now,  many  patients  do  go  out  and  shoot  methadone 
or  heroin  to  test  their  blockade.  He  will  not  have  any  euphoric  or  other 
effect. 


156 

There  are  several  reasons  a  person  might  continue  occasional  use  of 
heroin.  Many  persons  are  fearful  about  withdrawal  symptoms  and 
feel  they  must  take  increasing  doses  to  prevent  withdrawal  symptoms, 
even  though  they  can't  feel  the  drug  effects.  But  they  feel  very  anxious. 
We  had  one  patient  who,  when  a  private  doctor  recently  stopped  his 
practice  of  giving  methadone,  said,  "Oh,  I  didn't  want  to  tell  you  this, 
but  I  was  getting  a  second  dose  of  methadone  by  going  to  a  private 
doctor."  Since  there  is  no  central  registry  now  we  didn't  know  that. 
He  was  taking  two  doses  of  methadone  each  day.  "V^Tiat  he  was  doing, 
as  far  as  we  can  understand,  was  treating  his  anxiety  about  not  getting 
enough. 

The  treatment  was  to  counsel  the  patient,  to  help  him  see  that  he 
was  getting  enough  methadone,  and  he  stopped  taking  two  doses. 

Mr.  Wiggins.  Dr.  DuPont,  we  are  running  out  of  time,  and  I  would 
like  to  get  into  the  record  the  technique  you  employed  to  prevent  peo- 
ple from  abusing  your  program  by  obtaining  methadone  from  a  sec- 
ond source,  and  the  way  that  you  insure  that  those  who  take  it  home 
do  not  misuse  it.  Would  you  describe  your  security  procedure? 

Dr.  DuPoNT.  The  NTA  patient  takes  his  methadone  on  the  premises 
for  the  first  3  months  of  the  program,  and  then  he  gets  take-home 
privileges  of  gradually  increasing  duration  until  the  minimum  fre- 
quency allowed,  which  is  two  clinic  visits  per  week.  The  patient  must 
be  on  the  program  at  least  6  months  to  a  year  for  that  to  happen. 

The  patient's  urine  is  tested  twice  weekly.  Urine  tests  identify  all 
hard  drug  use,  but,  of  course,  we  can't  separate  a  second  dose  metha- 
done. But  we  know  that  a  person  is  not  going  to  more  than  one  of  our 
centers,  because  all  patients  come  in  and  have  their  pictures  taken  and 
get  an  I.D.  card.  It  is,  however,  possible  to  take  methadone  from  an- 
other source,  either  inside  the  city  or  out,  which  is  a  serious  problem. 

Mr.  WiGGixs.  What  w^ould  be  an  in-city  source  ? 

Dr.  DuPoNT.  A  private  physician.  A  person  could  also  go  to  Colo- 
nel Hassan's  program  and  register  for  that  program  and  receive  meth- 
adone and  not  be  in  our  central  register. 

Mr.  Steiger.  Is  he  still  conducting  his  program  ? 

Dr.  DuPoxT.  Yes ;  and  only  those  patients  for  whom  we  pay  him  in 
our  central  registry. 

Mr.  WiGGixs.  What  is  the  solution  to  that  problem  ? 

Dr.  DuPoxT.  The  solution  is  a  regional  registry  for  everybody  who 
gets  methadone.  Everybody  who  takes  a  dose  of  methadone  anywhere 
in  this  area  ought  to  be  required  to  be  in  a  central  register. 

Mr.  WiGGGixs.  How  central  ?  IMultistate  ? 

Dr.  DuPoxT.  We  should  ultimately  involve  Baltimore  as  well  as 
the  suburban  counties  in  Maryland  and  Virginia. 

Mr.  Steiger.  I  wonder  if  we  could  have  the  witness,  if  he  could  re- 
main? I  hate  to  impose  on  him,  but  I  think  all  of  us  would  like  to  ex- 
plore this. 

Chairman  Pepper.  Doctor,  could  you  wait  a  few  minutes  more? 

Dr.  DuPoxT.  Sure. 

Chairman  Pepper.  Doctor,  let  me  make  this  announcement  before 
we  recess.  We  will  come  back. 

Dr.  Jaffe  is  here,  another  distinguished  witness,  and  he  has  kindly 
consented  to  stay  over  until  tomorrow  morning.  Without  objection  on 


157 

the  part  of  the  committee,  when  we  do  recess  today  we  will  recess  un- 
til 9 :45  tomorrow  morning. 

AVe  will  take  a  temporary  recess  so  we  can  go  over  and  vote  again, 
Doctoi'.  We  are  sorry  to  put  you  to  so  much  trouble  today. 

(A  brief  recess  Avas  taken.) 

Chairman  Pepper.  The  committee  will  come  to  order,  please. 

Dr.  DuPont,  I  understand  you  have  some  problems  with  time  to- 
day, also. 

Dr.  DuPoNT.  Yes ;  I  do. 

Chairman  Pepper.  We  will  try  to  expedite  our  examination  of  you. 

Mr.  Steiger. 

Mr.  Stei«er.  Thank  you,  Mr.  Chairman. 

Doctor,  I  wanted  to  get  into  one  thing  about  half  opened  up  by 
your  testimony  and  others,  that  physicians  are  a  source  of  the  illegal 
methadone.  I  notice  that  in  almost  all  the  drug  hearings  we  have  had, 
and  the  committee  has  held  before,  even  in  other  areas,  there  is  a  great 
reluctance  to  admit  the  complacency  of  the  medical  profession.  I  say 
"complacent"  advisedly.  I  don't  mean  there  is  any  kind  of  conspiracy 
by  the  medical  profession  itself,  as  a  major  source  of  opiates. 

I  wonder  if  in  your  experience,  Xo.  1,  if  you  agree  that  it  could 
be  a  problem  not  only  in  methadone,  but  in  the  dispensing  of  other 
opiates,  and  if  the  equation  that  the  reason  for  many  of  the  people 
involved  in  your  program  and  the  New  York  City  program  are  the 
underprivileged  as  an  economic  matter  that  the  privileged  are  able 
to  buy  through  pseudolegitimate  source  the  wherewithal  to  feed  their 
habits :  is  this  a  valid  position  ? 

Dr.  DtPoxT.  There  are  so-called  medical  addicts  or  people  who 
have  become  addicted  through  medical  treatment.  This  does  not  neces- 
sarily involve  any  dereliction  on  the  part  of  the  physician,  although 
oftentimes  there  is  less  vigilance  than  probably  was  appropriate. 

On  the  other  hand,  I  don't  think  it  Avould  be  fair  to  say  that  opiate 
addiction  is  uniformly  distributed  throughout  the  population  by  so- 
cial class  and  that  the  lower  classes  don't  have  the  wherewithal  to  get 
it  and  the  upper  classes  do.  Opiate  addiction  is  concentrated  in  the 
loAver  social  classes,  even  adding  in  people  going  to  private  physicians. 

On  the  other  hand,  those  who  do  go  to  private  physicians  are  ob- 
viously from  the  upper  classes.  One  thing  we  have  noticed  in  the  Dis- 
trict is  that  whereas  about  8  peicent  of  the  overdose  deaths  in  the  city 
are  white,  only  about  4  percent  of  our  patients  are  white,  which  means 
that  there  is  an  underrepresentation  of  whites  in  our  patient  group. 
I  am  sure  that  this  is  accounted  for  by  more  white  addicts  going  to 
private  physicians. 

Mr.  Steiger.  That  is  a  very  interesting  statistic  and  I  can  draw  a 
lot  of  conclusions  from  it,  which  I  don't  want  to  do  superficially,  but 
I  am  glad  to  have  these  statistics. 

Now,  we  have  had  some  specific  instances  in  the  Phoenix,  Ariz.,  area 
in  which  physicians  were  actually  dispensing  narcotics  in  a  manner 
that  could  hardly  be  determined  medically  responsible.  I  don't  think 
it  serves  any  purpose  to  identify  it  as  a  racket,  but  just  as  irrespon- 
sibility. 

My  question  is :  In  your  experience,  how  widespread — I  will  phrase 
it  a  different  way. 


158 

It  would  seem  to  me  a  very  busy  physician  who  finds  it  reasonably 
profitable  and  could  justify  perhaps  in  his  own  mind  the  regular  pre- 
scription of  opiate  prescription  for  persons  who  didn't  require  much 
attention,  and  to  which  he  was  going  to  get  paid  for  each  prescription. 

Dr.  DuPoNT.  In  advance. 

Mr.  Steiger.  In  advance.  Is  that  the  way  it  works  ? 

We  have  now  taken  public  official  notice  of  the  private  physician  in 
regard  to  dispensing  of  methadone,  and  your  recommendation  there 
is  that  he  not  be  permitted  to  do  this  without  other  qualification, 
which  I  think  is  very  valid,  but  really  we  are  still  skirting  the  prob- 
lem. 

Dr.  DuPoNT.  It  is  still  going  on.  , 

Mr.  Steiger.  Well,  Ko.  1,  of  course,  there  is  no  way  to  control  it,  we 
understand  that.  We  all  know  we  are  talking  theory  here.  Short  of 
having  the  AMA  speak  to  its  own,  what  do  you  recommend  ? 

Dr.  DuPoNT.  Well,  the  AMA  has  spoken  to  its  own.  They  had  a 
release  about  a  month  ago  in  which  they  strongly  discouraged  private 
doctors. 

I  think  it  is  going  to  take  something  more  than  this.  I  am  not  an 
attorney,  but  what  I  understand  is  that  once  a  drug,  any  drug,  is  avail- 
able in  the  pharmacy,  any  pharmacy,  that  any  doctor  can  prescribe 
it  for  anything  he  wants  to.  There  are  certain  recommendations  that 
are  made  by  the  medical  profession  and  by  the  Food  and  Drug  Ad- 
ministration, but  these  do  not  have  the  force  of  law  and  the  doctor  can 
pretty  much  do  what  he  wants. 

Methadone  is  an  established  drug  available  in  every  pharmacy.  I 
wonder  if  it  wouldn't  require  some  sort  of  legislative  action  to  make 
methadone  an  exception  and  to  bring  it  under  control. 

You  might  pursue  this  with  subsequent  witnesses  who  can  speak 
more  authoritatively,  because  I  think  it  is  a  very  serious  problem  when 
Federal  agencies  and  other  groups  pretend  to  have  the  power  to  curb 
certain  kinds  of  behavior  that  are  considered  to  be  undesirable  but 
really  don't  have  that  power.  The  question  is  whether  thev  do  have 
the  power;  if  they  do  have  the  power,  then  why  has  nothing  been 
done? 

I  think  many  people  are  misled  and  believe  that  power  exists  when 
it  doesn't. 

Mr.  Steiger.  Good. 

Thank  you.  Doctor,  I  have  no  further  questions. 

Chairman  Pepper.  Is  that  all  ? 

Mr.  Steiger.  Yes. 

Chairman  Peppek.  Mr.  Kangel,  have  you  inquired  of  Dr.  DuPont? 

Mr.  Rangel.  Doctor,  in  your  medical  experience,  have  you  ever 
found  a  national  health  problem  such  as  drug  addiction  being  treated 
as  you  are  treating  it  with — and  multimethods  of  service  and  com- 
munity controls?  Is  this  a  usual  way  to  treat  a  problem  of  such 
enormity  ? 

Dr.  DuPont.  I  don't  think  there  is  anything  usual  about  heroin 
addiction.  I  don't  know  what  the  analogy  would  be.  I  think  it  is  very 
exceptional. 

Mr.  Rangel.  This  is  a  very  exceptional  method  of  treatment  of  any 
problem,  any  medical  problem  of  this  sort,  isn't  it  ? 

Dr.  DuPoxT.  I  think  so.  I  am  not  sure  where  I  am  being  led  to,  but 
I  will  say,  "Yes,"  and  put  an  asterisk  after  it. 


159 

Mr.  Rangel.  Well,  I  wasn't  goin^  to  lead  you  any  further,  but  I 
wonder  if  we  were  talking  about  a  different  economic  class  of  people, 
whether  or  not  those  in  the  medical  profession  would  be  more  prone 
to  have  this  type  of  community  control  over  dispensation  of  drugs. 

Dr.  DuPoxT.  That  is  a  good  point.  If  it  were  a  different  social  class 
I  don't  think  the  problem  would  have  gone  on  in  Harlem  as  long  as  it 
did  without  any  treatment  at  all.  It  wasn't  until  the  majority  of  the 
country,  the  more  affluent  part  of  the  country,  in  any  event,  became 
very  frightened  about  crime  rates  in  their  cities,  and  until  they  got 
concerned  about  their  own  junior  and  senior  high  school  children  using 
drugs  that  we  got  a  national  commitment. 

But  it  is  coming  and  I  think  it  is  to  everybody's  benefit. 

Mr.  Rangel.  This  national  commitment,  as  far  as  I  can  see  in  the 
area  of  rehabilitation,  it  has  settled  down  to  the  question  of  expand- 
ing methadone  treatment ;  has  it  not  ? 

Dr.  DuPoxT.  No ;  I  don't  think  that  is  true. 

Mr.  Raxgel.  How  much  time  does  your  institution  spend  on  devel- 
oping scientific  methods  of  curing  this,  other  than  methadone  ? 

Dr.  DuPoxT.  Well,  about  25  percent  of  our  patients  are  not  on 
methadone,  for  example. 

Mr.  Raxgel.  But  are  you  looking  for  other  scientific  cures  ? 

Dr.  DuPoxT.  No;  we  don't  do  any  basic  research.  That  would  be 
more  properly  done  elsewhere.  We  are  a  city  treatment  agency. 

Mr.  Raxgel.  But  you  have  no  national  institution  that  you  can  go  to 
in  order  to  increase  your  ability  to  deal  with  the  drug  addiction  prob- 
lem ;  do  you  ? 

Dr.  DuPoxT.  Well,  the  National  Institute  of  Mental  Health  is  prob- 
ably one  of  the  logical  sources  for  this  kind  of  activity.  In  fairness  to 
them,  some  activity  is  going  on  there,  but  very  little. 

Mr.  Raxgel.  Have  they  been  of  any  assistance  to  you  to  reach  a 
program  Avhere  you  could  professionally  feel  that  you  are  doing  the 
best  you  can  with  what  is  available  ?  Have  they  assisted  you  in  devel- 
oping your  program  ? 

Dr.  DuPoxT.  Yes;  they  have  given  us  $800,000  a  year  for  one  major 
component  of  our  program. 

Mr.  Raxgel.  I  am  not  making  myself  clear.  I  am  not  talking  about 
the  money.  I  am  talking  about  you,  as  a  doctor,  with  your  background. 

Dr.  DuPoxT.  I  see. 

Mr.  Raxgel.  Have  you  got  a  national  institution  that  can  give  you 
scientific  data  as  a  result  of  their  research  that  you  can  depend  on  so 
that  perhaps  you  could  expand  and  develop  other  methods  of  treating 
drug  addicts,  other  than  methods  of  Colonel  Hassan  ? 

Dr.  DuPoxT.  No. 

Mr.  Raxgel.  So  that  as  far  as  you  are  concerned,  all  you  have  is  what 
New  York  City  has  done  as  a  basis  of  where  you  are  going  ? 

Dr.  DuPoxT.  Well,  I  think  Chicago  and  Dr.  Jaffe  added  something 
very  important  to  the  New  York  experience,  and  that  was  the  concept 
of  a  multimodality  program.  So  I  think  there  are  other  additions,  and 
I  think  all  over  the  country  there  are  a  lot  of  very  resourceful  and 
energetic  people  who  are  involved  from  a  variety  of  sources. 

For  instance,  in  Stanford  University,  Professor  Goldstein,  who  is  a 
pharmacologist,  made  a  very  important  contribution,  for  example,  with 
a  urine  testing  technique  which  promises  a  lot  of  advantages  over  what 


160 

we  had  before.  I  don't  think  it  is  quite  fair  to  say  there  is  no  where 
to  turn. 

Mr.  Kangel.  I  am  talking  about  on  a  national  level. 

Dr.  DuPoNT.  I  think  the  national  agencies  have  provided  very  little, 
approaching  nothing. 

Mr.  Kangel.  You  said  earlier  that  there  was  no  difference  between 
a  heroin  addict  and  a  methadone  addict,  and  I  agree  with  what  you 
and  I  have  seen  in  central  Harlem. 

On  the  other  hand,  other  people  have  testified  there  is  no  difference 
between  a  methadone  addict  and  a  diabetic.  I  see  a  large  medical 
credibility  gap  between  those  two  statements. 

Dr.  DuPoNT.  Well,  I  think  Mr.  Blommer  and  I  were  talking  about 
the  "addict"  as  different  from  the  "dependent."  Dr.  Gearing  made 
this  distinctioii.  We  are  going  to  have  to  make  a  distinction  between 
the  person  who  is  taking  methadone  and  is  dependent  upon  it  as  part 
of  a  structural  program  and  the  so-called  addict.  Both  are  technically 
addicted,  although  the  behavior  one  observes  is  quite  different. 

Mr.  Kangel.  Let  me  just  use  your  terminology.  Is  there  any  dif- 
ference between  a  person  dependent  on  heroin  and  a  person  dependent 
on  methadone  ? 

Dr.  DuPoNT.  Yes;  I  think  there  is  a  dramatic  difference.  It  is  as- 
sociated with  the  drug  and  also  with  where  it  comes  from. 

Mr.  Kangel.  Didn't  you  say  earlier  there  was  no  difference  between 
a  heroin  addict  and  a  methadone  addict  ? 

Dr.  DuPoNT.  When  it  is  out  on  the  street  and  people  are  shooting 
it  and  are  pursuing  an  addict  life  style,  there  is  no  difference. 

Mr.  Kangel.  To  put  it  another  way,  if  we  were  to  dispense  heroin 
or  have  a  heroin  maintenance  program,  then  would  there  be  any  dif- 
ference, taking  out  the  life  style  of  the  street  and  heroin  maintenance 
program  and  your  methadone  maintenance  program? 

Dr.  DuPoNT.  Yes ;  there  would  be.  I  think  there  are  pharmacological 
advantages  to  methadone,  which  is  very  important.  One  is  that  metha- 
done needs  to  be  taken  once  a  day  instead  of  three  or  four  times  a  day 
as  with  heroin.  That  is  a  very  important  distinction. 

Another  difference  is  that  methadone  can  be  taken  orally  rather  than 
injected.  Many  of  the  problems  associated  with  heroin  addiction  have 
to  do  with  its  being  injected. 

Perhaps  even  more  important,  methadone  allows  the  person  to  be 
stabilized  at  a  dose  and  he  doesn't  continue  to  crave  for  increasing 
amounts. 

The  fact  is  that  most  people  "maintained"  on  heroin — for  exam- 
ple, in  the  British  clinics — are  dropouts  from  society.  This  is  not  the 
typical  experience  with  the  methadone-dependent  patient  in  a  pro- 
gram. He  is  a  person  who  is  able  to  call  on  his  own  inner  strength  and 
pursue  a  life  course  that  makes  sense,  including  productive  prosocial 
work. 

I  think  the  personal  experience  of  seeing  the  persons  in  a  methadone 
program  is  dramatic. 

I  was  with  the  Department  of  Corrections  a  little  oyer  2  years  ago 
and  had  no  interest  in  or  special  knowledge  about  this  field.  I  went 
through  a  very  personally  moving  experience  when  I  first  visited  a 
methadone  program  and  talked  to  the  patients.  This  experience  meant 
more  to  me  than  all  of  Dr.  Gearing's  charts.  But  I  was  impressed  by 


161 

the  sincerity  of  many  of  these  people  as  they  described  the  difference 
of  their  lives  and  their  families  after  methadone  treatment.  You  talk, 
for  example,  to  the  wives  of  men  who  are  in  the  program,  and  they 
are  appreciative  of  the  changes  that  have  come  about  in  their 
husbands. 

Mr.  Eangel.  You  can't  attribute  all  of  this  to  methadone. 

Dr.  DuPoNT.  No,  I  don't.  I  think  a  lot  of  it  has  to  do  with  the  pro- 
gram, but  I  think  the  programs  could  not  function  without  methadone. 
If  you  put  a  head-to-head  kind  of  test  with  just  the  ancillary  services 
in  one  and  the  other  you  had  the  ancillary  services  plus  methadone, 
you  would  get  10  percent  effect  in  the  one  with  ancillary  services  and 
90  percent  in  the  other. 

I  don't  think  you  should  underestimate  the  effect  of  methadone  in 
dealing  with  chronic  heroin  addiction. 

Mr.  Rangel.  But  you  don't  know  if  you  were  able  to  give  all  of 
these  services  to  youngsters  not  addicted  to  anything  whether  or  not 
you  would  still  feel  great  that  you  were  helping  youngsters  ? 

Dr.  DuPoNT.  I  think  youngsters  need  all  of  the  services,  regard- 
less of  whether  they  are  taking  heroin,  especially  employment  oppor- 
tunities. There  are  great  segments  of  our  society  who  don't  have 
enough  opportunities  now,  whether  they  are  on  a  program  or  not. 

That  is  another  thing  that  happens  to  you  when  you  work  with  these 
people,  vou  learn  that. 

Mr.  Rangel.  Would  you  consider  your  patients  normal?  Some- 
one said  earlier,  a  witness  testified  that  they  believed  that  the  metha- 
done patient  would  always  be  dependent  on  drugs.  Now,  you  have 
different  programs,  but  you  do  have  one  that  does  not  try  to  diminish 
the  amount  of  methadone,  and  is  it  fair  to  say  that  the  person  included 
in  this  program  will  always  be  dependent  on  methadone  ? 

Dr.  DuPoNT.  No ;  it  isn't  fair  to  say  that,  because  some  will  try  at 
later  points  to  come  off  and  some  of  those  people  will  make  it. 

Mr.  Rangel.  During  this  period  of  time,  how  do  you  as  a  doctor 
distinguish  between  them  and  so-called  normal  people  who  are 

Dr.  DuPoNT.  You  can't  tell  any  difference.  The  only  way  is  the 
urine  test. 

Mr.  Rangel.  But  how  do  they  function  ? 

Dr.  DuPoNT.  Methadone  maintained  patients  function  perfectly 
normally.  To  add  to  this  a  little  bit,  I  have  never  seen  this  in  writing 
and  I  hope  it  is  not  denied,  but  it  is,  I  understand,  the  case  that  the 
District  of  Columbia  Motor  Vehicles  Bureau  has  been  very  interested 
in  how  our  methadone  people  have  been  faring  in  terms  of  accidents. 
Although  they  have  a  list  of  quite  a  number  of  our  patients  asking 
for  permits  about  whom  we  have  written  saying  they  are  rehabilitated. 
So  far,  these  patients  haven't  had  the  first  accident.  The  Motor  Ve- 
hicles Bureau  said  facetiously,  that  methadone  maintenance  may  not 
only  reduce  crhne  but  also  reduce  auto  accidents. 

But  I  think  the  point  is  very  important.  These  people  do  perform 
normally. 

The  same  thing  goes  on  with  employers.  As  Dr.  Gearing  said,  em- 
ployers are  quite  skeptical  about  methadone.  Many  have  learned  from 
experience  that  methadone  maintenance  patients  make  good  employees. 

But  again  I  want  to  emphasize  what  I  think  you  are  saying,  which 
is  that  there  are  vast  unmet  needs  in  the  community  which  spawn 


162 

heroin  addiction  and  support  all  kinds  of  destructive  behavior.  Meth- 
adone does  nothing  about  those  problems. 

Mr.  Rangel.  Thank  you. 

Chairman  Pepper.  Mr.  Keating. 

Mr.  Keating.  Doctor,  did  I  understand  you  earlier  to  indicate  that 
there  were  26  deaths  attributed  to  the  methadone,  or  did  I  hear  you 
incorrectly  ? 

Dr.  DuPoNT.  Twenty-three  that  involved  methadone.  Not  all  you 
could  say  could  be  attributed  to  methadone,  because  many  of  them 
also  had  heroin  as  well.  There  were  a  total  of  14  of  the  23  that  did  not 
involve  heroin  also. 

Mr.  Keating.  Breaking  that  down,  did  you  indicate  that  five  were 
associated  in  some  way  or  another  with  your  group  ? 

Dr.  DuPoNT.  Five  out  of  the  23  and  three  out  of  the  14. 

Mr.  Keating.  How  were  you  able  to  determine  if  these  were  asso- 
ciated with  a  drug  dispensed  by  your  organization  ? 

Dr.  DuPont.  Well,  two  of  them  were  patients  who  were  in  our  pro- 
gram 2  days,  one  of  whom  took  heroin  and  alcohol  along  with  the 
methadone  and  died  of  a  multiple  overdose. 

The  second  was  a  young  woman  who  was  in  the  second  day  of  the 
program  and  felt  sick  in  the  evening  after  taking  her  dose  at  8  o'clock. 
She  went  to  bed,  vomited  in  her  sleep,  inhaled  the  vomit  into  her 
lungs,  and  died.  Those  were  the  only  two  patients  to  die  of  overdoses. 

A  third  death  was  a  person  who  was  put  into  a  cab  and  who  was 
about  to  die  of  an  overdose.  The  cab  raced  to  the  hospital  but  the 
driver  noticed  that  the  person  who  put  him  in  the  cab  threw  some- 
thing into  the  street  that  was  not  identifiable.  The  policeman  was  told 
about  this.  When  he  came  back  and  looked  in  the  street  he  found  a 
bottle  with  an  NTA  label.  But  we  count  that  as  a  death  that  may  have 
had  something  to  do  with  our  methadone.  Two  other  cases  occurred 
when  people  not  in  the  treatment  program  were  given  bottles  of  NTA 
methadone  and  died  of  overdoses.  Both  included  heroin  as  well  as 
methadone ;  that  is,  they  participated  in  an  addict  drug-taking  experi- 
ence which  involved  methadone. 

That  is  the  total :  Five. 

Mr.  Keating.  Have  you  had  any  deaths  that  were  attributed  to 
people  who  took  the  methadone  from  the  clinic  to  take  at  home  or  as 
a  result  of  that  procedure  ?  You  know,  you  have  some  people  that  only 
come  in  twice  a  week. 

Dr.  DuPoNT.  No  patient  who  has  been  on  the  program  longer  than 
2  days  has  died  from  an  overdose  of  anything. 

Mr.  Keating.  I  think  that  helps  clear  up  a  number  of  questions  I 
had.  How  do  you  ascertain  the  previous  experience  of  the  patient  in 
terms  of  heroin  or  methadone  or  some  other  drug? 

Dr.  DuPoNT.  We  ask  them  and  record  the  information  about  when 
they  say  they  first  begun  to  use  each  of  the  numerous  illegal  drugs, 
including  methadone  and  heroin. 

We  also  take  a  urine  test  at  the  beginning  of  the  treatment.  It  re- 
mains possible  for  a  person  who  is  not  an  opiate  addict  to  get  into  our 
program  and  to  continue  to  participate  in  the  program  without  ever 
having  been  an  opiate  addict. 

For  example,  if  a  person  would  drink  a  bottle  of  tonic  water,  such 
as  gin  and  tonic,  it  would  produce  quinine  in  the  urine,  which  is  a  com- 


163 

mon  finding  with  people  iisino;  heroin.  We  would  tabulate  that  as 
heroin  "positive."  But  such  an  impostor  would  have  to  drink  the  meth- 
adone on  the  NTA  premises  for  3  consecutive  months  and  give  us  a 
urine  sample  twice  a  week.  We  haven't  had  any  investigators  or  re- 
porters that  pursue  that  course.  Whether  there  are  people,  children  or 
otherwise,  who  have  gone  through  this  process  and  are  not  bona  fide 
addicts  in  the  first  place,  we  don't  know. 

Mr.  Keating.  How  do  you  know  what  level  to  start  them  ? 

Dr.  DuPoNT.  On  the  basis  of  what  they  tell  us.  A  person  who  is 
young  would  get  a  smaller  dose  and  a  person  without  a  lot  of  track 
marks  would  get  a  smaller  dose,  and  an  older  person  with  a  lot  of  track 
marks  would  get  a  larger  dose.  In  all  cases,  the  dose  is  from  20  to  50 
milligrams  to  start. 

Mr.  Keating.  Do  you  have  any  information  of  somebody  coming  in 
and  getting  started  in  your  program  ?  I  think  this  question  was  asked 
earlier.  Is  that  a  constant  concern  of  yours  ? 

Dr.  DuPoNT.  I  am  concerned  about  it  from  a  theoretical  point  of 
view.  I  don't  have  any  evidence  of  that  happening.  My  impression  is 
it  is  unlikely  because  the  methadone  treatment  in  my  experience  is  not 
a  positive  one  in  terms  of  pleasure.  It  is  certainly  disruptive  to  a  per- 
son's life  to  come  in  every  day  for  3  months  and  fill  out  all  the  forms, 
get  an  I.D.  card,  and  to  give  us  urine  specimens  twice  a  week.  This 
would  deter,  I  think,  a  casual  fake  from  coming  in. 

On  the  other  hand,  I  am  concerned  about  it  and  if  there  was  some 
evidence  to  the  contrary  I  would  like  to  know  about  it.  We  are  really 
quite  concerned.  There  isn't  any  obvious  way  to  find  that  out,  though. 

Mr.  Keating.  You  indicated  a  patient  needs  a  choice  of  modality. 
How  many  different  choices  do  you  provide? 

Dr.  DuPoNT.  There  are  15  centers  in  the  city  right  now,  not  that 
everybody  can  choose  each  one  of  them.  For  example,  some  of  them  are 
restricted  to  geographic  areas.  So  if  a  patient  doesn't  live  in  that  geo- 
graphic area  he  can't  go  there.  But  every  person  can  choose  at  least 
detoxification  on  methadone  with  dex^reasing  dosages,  or  methadone 
maintenance,  unless  he  is  under  18  years  of  age  or  reports  a  history  of 
addiction  less  than  1  year,  in  which  case  he  cannot  choose  methadone 
maintenance.  Each  patient  can  choose  an  abstinence  program  and  come 
in  and  give  a  urine  sample  and  participate  in  counseling  programs. 

Mr.  Keating.  Do  you  check  any  police  records  as  part  of  your 
procedure,  before  you  put  them  on  your  program? 

Dr.  DuPoNT.  No.  This  is  certainly  a  good  thought.  We  are  now  con- 
sidering trying  to  identify  arrest  records  earlier,  and  if  we  can't,  to 
make  extra  efforts  to  make  sure  we  have  the  correct  identification. 

Our  initial  attempts  to  make  positive  identification  were  not  as 
strict  as  they  are  now.  Our  current  procedure  is  to  find  a  driver's 
license  or  something  else  to  confirm  identification. 

In  other  words,  we  just  don't  take  the  person's  word  for  his  name, 
the  way  we  did  earlier  in  the  program.  Everybody  who  now  has  his 
identification  renewed  is  expected  to  go  through' this  same  process 
of  proving  who  he  is. 

Mr.  Keating.  Is  there  any  procedure  during  the  course  of  your 
treatment  that  would  lead  to  a  counseling  that  would  try  to  persuade 
the  person  to  abstain  ? 

Is  there  any  effort  in  this  direction  ? 


164 

Dr.  DuPoNT.  I  am  reluctant  to  get  involved  in  encouraging  that 
unless  there  is  some  reason  to  believe  it  is  likely  to  succeed.  It  is  very 
hurtful  to  people  to  talk  them  off  methadone  when  they  really  need  to 
be  on  it.  We  have  had  some  very  bad  experiences  with  people  who 
have  discontinued  methadone  under  some  overt  or  covert  staff  pres- 
sures and  then  who  go  back  to  heroin  and  leave  the  program. 

Mr.  Steiger.  Excuse  me. 

Mr.  Keating.  Yes. 

Mr.  Steiger.  A  person  who  is  addicted  or  dependent  on  methadone 
in  the  oral  form,  and  he  abstains,  are  his  withdrawal  symptoms  phys- 
ically as  stringent  as  the  heroin  addict  ? 

Dr.  DtrPoNT.  They  tend  to  be,  dose-for-dose,  less  intense  and  of 
longer  duration,  but,  of  course,  the  dose-for-dose  qualification  is  im- 
portant because  the  street  heroin  addict  is  likely  to  have  a  smaller 
total  dose.  The  peo]:)le  who  are  on  methadone  maintenance  have  very 
painful  withdrawal  symptoms  if  they  stop  abruptly.  If  they  detoxify 
over  weeks  or  months  the  common  experience  is  easy  until  the  patient 
is  down  to  about  20  or  30  milligrams  a  day,  at  which  time  he  will  start 
developing  hunger  for  the  drug  again  and  he  may  start  shooting  heroin 
again. 

When  he  takes  his  last  dose  of  methadone,  if  he  doesn't  go  back  to 
heroin,  he  will  have  insomnia,  aching  of  his  joints  and  muscles,  which 
will  last  for  several  days  to  several  weeks. 

Chairman  Pepper.  Mr.  Brasco  ? 

Mr.  Brasco.  Thank  you. 

There  are  several  observations  that  have  been  made,  Doctor,  and  it 
is  sort  of  puzzling  me.  I  share  the  concern  of  my  colleagues  about  the 
problem  of  methadone  traffic  in  the  street.  It  would  appear  to  me  that 
if  there  is  no  euphoria  attached  to  drinking  meliadone,  then  there 
would  be  no  need  or  no  reason  for  an  addict  to  be  taking  it  in  the  street, 
unless 

Dr.  DuPoxT.  He  shoots  it,  they  inject  it. 

Mr.  Brasco.  All  right.  Now,  the  next  thing  is  if  he  does  that  and 
based  on  my  own  experience  in  the  area,  having  practiced  criminal  law 
for  some  10  years,  addicts  are  not  stupid  when  it  comes  to  their  own 
needs. 

Are  the  problems  that  you  talk  about  concerning  greater  withdrawal 
effects  in  usmg  methadone,  and  obviously  if  they  are  obtaining  it 
illicitly  they  are  paying  for  it  anyway.  Wliat  would  be  the  advantage 
of  using  methadone  when  an  addict  can  get  heroin  in  the  streets  easily. 

Dr.  DuPoNT.  Well,  if  the  methadone  is  cheaper  he  would  take  the 
methadone,  and  I  think  with  the  widespread  availability  of  methadone 
on  the  street  it  is  cheaper,  dose  for  dose. 

Mr.  Brasco.  So  what  you  are  basically  saying  is  that  the  people  that 
are  trafficking  in  the  street  are  using  it  to  shoot  it  up  because  of  the 
availability  and  the  fact  that  it  is  cheaper  ? 

Dr.  DuPoxT.  Oh,  yes. 

Mr.  Brasco.  One  other  thing. 

I  agree  with  my  colleague,  Mr.  Rangel,  that  the  support  programs 
surrounding  the  methadone  program  that  Dr.  Gearing  talked  about,  if 
they  were  given  to  underprivileged  people  without  the  problem  of 
addiction  they  would  be  very  effective  in  doing  a  job  to  lessen  crime 
rates  in  deprived  areas.  But  in  your  program  I  am  wondering  whether 


165 

or  not  there  is  great  resistance  in  the  job  opportunity  areas,  based  on 
two  reasons : 

One,  the  fact  that  the  individual  is  an  addict  in  your  program ;  and 
two,  this  question  of  the  previous  record  of  an  individual,  which  seems 
to  me  probably  to  be  the  most  destructive  force  that  we  have  in  our 
area  of  rehabilitation.  I  am  wondering  if  we  were  able  to  devise  some 
kind  of  system  where  we  could  do  away  with  a  criminal  record  follow- 
ing you  around  for  the  rest  of  your  life,  whether  or  not  that  would  be 
helpful  in  terms  of  the  effectiveness  of  your  program,  at  least  the 
followup  portion,  the  job  aspects? 

Dr.  DuPoNT.  Well,  it  might  be.  It  certainly  wouldn't  hurt.  But  I 
think  you  have  to  keep  in  mind  that  the  average  educational  level  of 
the  patients  in  our  program  is  10th  grade.  That  is,  half  the  people  have 
dropped  out  by  the  time  the  10th  grade  has  come  around.  So  we  have 
some  serious  handicaps  here  of  an  educational  nature  that  are  not 
going  to  be  dealt  with  simply  by  eliminating  the  arrest  record. 

I  think  in  some  respects  I  would  like  to  put  in  a  qualification  on  the 
ancillary  services  and  dealing  with  the  patients'  problems.  I  don't 
know  where  the  evidence  is  about  job  training,  for  example,  or  psycho- 
logical counseling  in  terms  of  reducing  unemployment,  or  many  other 
things. 

I  think  that  the  whole  manpower  question  really  needs  a  very  hard 
look  at  what  is  going:  on.  I  am  taking  the  position  that  it  is  not  just 
training  that  is  needed,  but  opportunities  for  work.  You  can  have  a 
lot  of  training  go  on  and  put  an  awful  lot  of  money  into  training  pro- 
grams that  don't  really  go  anywhere. 

Mr.  Brasco.  Let  nie  just  rephrase  the  last  question  another  way: 

Getting  away  from  the  program  that  you  are  talking  about  and  in 
the  area  that  you  are  expert  in,  do  you  think  that  cari-ying  a  prior 
record  around  for  the  rest  of  your  life  serves  any  purpose  other  than 
to  deprive  people  of  job  opportunities  ? 

Dr.  DuPoNT.  I  think  it  does  deprive  people  of  job  opportunities, 
but,  perhaps,  not  as  many  as  you  may  be  thinking.  It  is  possible  in  many 
circumstances  to  establish  an  identity  as  a  rehabilitated  former  offender 
that  is  quite  positive  and  constructive. 

I  don't  think  it  is  necessarily  a  bar  forever.  There  is  some  evidence 
of  social  change  about  this.  Businesses,  I  think,  now  are  more  con- 
cerned about  social  responsibilities  in  terms  of  reducing  criminal  be- 
havior by  providing  job  opportunities,  more  so  than  they  were  5  years 
ago. 

Mr.  Brasco.  Thank  you. 

Chairman  Pepper.  Dr.  DuPont,  I  just  want  to  ask  you  one  question : 

You  estimated  there  were  16,800  addicts  of  heroin  in  the  District  of 
Columbia.  You  testified  you  had  3,160  in  your  treatment  program  and 
most  of  the  rest  of  them  are  not  being  treated. 

Now,  how  much  money  would  it  take,  according  to  your  best  esti- 
mate, to  provide  the  best  known  treatment  to  all  the  addicts  of  the 
District  of  Columbia? 

Dr.  DuPoNT.  Mr.  Chairman,  our  best  estimates  are  that  it  costs 
about  $2,000  a  patient-year  to  provide  comprehensive  multimodality 
treatment. 

That  amount  of  money  in  no  way  meets  all  the  needs  of  these  people, 
including  health  and  training,  et  cetera.  But  it  meets  many  of  them. 


166 

Using  this  figure  as  rule  of  thumb,  it  would  take  about  $34  million 
to  treat  16,800  heroin  addicts. 

Chairman  Pepper.  You  are  now  getting  a  total  of  about  $5,100,000 
for  the  program  from  the  District  and  Federal  Governments  ? 

Dr.  Du  Pont.  Yes  sir. 

Chairman  Pepper.  Well,  thank  you  very  much.  Doctor.  We  appreci- 
ate your  coming. 

I  am  sorry  to  have  kept  you  so  long. 

We  want  publicly  to  thank  Dr.  Jaffe  again  for  his  willingness  to 
stay  over  and  let  us  hear  him  tomorrow  morning. 

We  will  recess  until  9 :45  tomorrow  morning,  in  room  2253,  and  we 
win  be  back  in  this  room  at  10  o'clock  Thursday. 

Without  objection,  the  insertions  will  be  included  in  the  record. 

Mr.  Perito.  For  the  record,  Mr.  Chairman,  exhibit  No.  11(a)  is  en- 
titled "Profile  of  the  Heroin  Addiction  Epidemic." 

Exhibit  No.  11(b)  is  dated  January  12, 1971,  and  entitled  "Summary 
of  6  Months  Follow  Up  Study." 

Exhibit  No.  11(c)  is  in  the  handwriting  of  Dr.  DuPont  and  is  en- 
titled'JDr  DuPont's  Numbers." 

Exhibit  No.  11(d)  is  dated  January  1971  and  entitled  "Administra- 
tive Order." 

Exhibit  No.  11(e)  is  entitled  "A  Study  of  Narcotics  Addicted  Of- 
fenders at  the  D.  C.  Jail." 

(The  exhibits  referred  to  above  follow :) 

[Exhibit  No.  11(a)] 

Profile  of  a  Heroin  Addiction  Epidemic 

(By  Robert  L.   DuPont,  M.D.,  D'rector,  Narcotics  Treatment  Administration, 

Washington,  D.C.) 

Abstract 

Washington,  D.C,  is  experiencing  an  alarming  epidemic  of  heroin  addiction. 
According  to  current  estimates  there  are  now  about  17,000  heroin  addicts  in  the 
city. 

Two-thirds  of  the  addicts  are  under  26  years  of  age,  91  percent  are  black,  74 
percent  are  male,  and  52  percent  began  heroin  use  within  the  last  4  years.  In  one 
large  part  of  the  central  city  it  is  estimated  that  20  percent  of  the  boys  agei  15 
to  19  and  38  percent  of  the  young  men  20  to  24  are  heroin  addicts. 

A  major  treatment  program  has  been  implemented  in  Washington  which  is  now 
treating  3,000  heroin  addicts  of  whom  about  75  percent  receive  methadone. 

An  initial  performance  study  found  that  55  percent  of  all  patients  remained  in 
the  program  after  6  months  and  that  86  percent  of  those  on  methadone  main- 
tenance were  retained  in  the  program  during  the  6-month  study.  Among  the 
patients  treated,  heroin  use  decreased,  arrest  rates  fell,  and  employment  rates 
rose. 

Introduction 

Washington,  D.C,  Is  engulfed  by  an  alarming  epidemic  of  heroin  addiction. 
Increasingly  sophisticated  research  information  accumulated  over  the  course  of 
the  last  year  demonstrates  this  without  a  doubt.  It  is  now  estimated  that  there 
are  16,800  heroin  addicts  in  the  city,  or  2.2  percent  of  the  total  population  of 
756,510.  The  social  and  personal  losses  are  tremendous.  The  related  crime  rate  is 
appalling. 

But  the  figures  do  not  stop  with  the  tragic  consequences  of  heroin  addiction  in 
the  Nation's  Capital.  Limited  data  available  from  metropolitan  areas  around  the 
country  suggests  that  these  cities  are  also  experiencing  the  epidemic. 

Upon  recognizing  that  heroin  addiction  was  such  a  disastrous  problem  in 
Washington,  D.C,  the  largest  and  fastest  growing  municipal  treatment  program 


167 

in  the  Nation,  the  Narcotics  Treatment  Administration,  was  begun  in  February 
1970.  Nevertheless,  it  is  obvious  that  even  this  effort  is  grossly  inadequate  for 
the  needs  of  the  Washington  community. 

What  is  known  of  the  epidemic  in  Washington?  How  many  heroin  addicts 
are  there?  Where  do  heroin  addicts  live  in  the  city?  What  are  the  basic  char- 
acteristics of  the  addict  population?  When  did  the  epidemic  begin?  Is  it  getting 
worse?  What  is  the  relationship  between  the  distribution  of  addiction  in  the  city 
and  other  social  factors  including  crime  and  poverty?  How  much  does  the 
epidemic  cost  the  community  ?  What  can  be  done  about  it? 

This  paper  attempts  to  answer  these  vital  questions  and  should  be  useful  to 
the  Washington,  D.C.,  community  and  to  other  cities  and  States  which  know  far 
less  about  their  problems  with  heroin  addiction. 

How  many  heroin  addicts  are  there? 

In  the  summer  of  1969  the  only  basis  for  estimating  the  Washington  addict 
population  was  the  Bureau  of  Narcotics  and  Dangerous  Drugs  (Justice  Depart- 
ment) 1968  list  of  1,162  addicts  in  Washington.  However,  in  August  1969  a  study 
at  the  District  of  Columbia  jail  showed  that  45  percent  of  all  new  admissions 
were  heroin  addicts.  Only  27  percent  of  the  men  identified  as  addicts  by  inter- 
view and  urine  testing  were  previously  known  to  the  BNDD  (1). 

On  the  basis  of  this  new  information,  the  estimate  of  the  total  number  of 
addicts  was  raised  to  3.7  times  1,162  or  4,300  addicts.  Next,  in  cooperation  with 
the  District  of  Columbia  coroner,  an  analysis  was  made  of  the  total  number  of 
known  opioid  overdose  deaths  in  Washington.  An  opioid  overdose  death  is  a  sud- 
den death,  without  other  cause,  of  an  individual  whose  urine  or  other  tissues 
contain  an  opioid  drug  such  as  heroin,  morphine,  or  methadone  (3).  In  1967  the 
number  was  21.  Using  the  Baden  formula  (2)  that  one  of  every  200  heroin  addicts 
dies  of  an  overdose  reaction  each  year,  the  total  number  of  District  of  Columbia 
heroin  addicts  appeared  to  be  4,200  for  1969.  However,  there  were  13  overdose 
deaths  in  the  first  3  months  of  1970.  This  was  equivalent  to  52  per  year  and  indi- 
cated a  total  addict  population  of  10,400  using  the  Baden  formula.  During  the 
first  6  months  of  1970  a  total  of  21  people  died  of  overdoses.  Thus,  in  the  first  6 
months  of  1970,  the  same  number  died  of  overdose  reactions  as  died  in  all  of  1969. 

In  July  1970,  again  in  cooperation  with  the  District  of  Columbia  coroner,  a 
new  more  systematic  procedure  was  developed.  Complete  narcotics  drug  screens 
(using  gas  liquid  chromatography)  were  performed  on  all  autopsied  deaths  of 
individuals  between  the  ages  of  10  and  40  as  well  as  individuals  younger  or 
older  who  showed  evidence  of  drug  use.  During  the  next  6  months,  42  people  were 
identified  as  dying  of  opioid  overdose  reactions.  The  annual  rate  was  84.  The 
estimate  of  total  heroin  addicts  was  accordingly  raised  to  16,800. 

During  the  calendar  year  1968  a  total  of  875  narcotic  addict  information  forms 
were  received  by  the  Biostatistics  Division  of  the  District  of  Columbia  Health 
Services  Administration.  In  1969  one  of  these  individuals  died  of  an  opioid  over- 
dose. During  1970  three  died  of  opioid  overdose  reactions.  Thus  the  rate  of  death 
was  one  per  438  man-years.  This  data  was  not  used  to  compute  a  '^Washington 
formula"  because  the  numbers  are  small,  but  it  suggests  that  the  multiplier  used 
by  Baden  in  New  York  may  be  low  for  Washington.  If  this  is  true,  then  the  cur- 
rent estimate  of  16,800  heroin  addicts  in  Washington  may  also  be  low. 

It  should  be  noted  that  the  increase  in  the  rate  of  overdose  deaths  in  the  last 
2  years  did  not  reflect  only  increased  heroin  use.  In  part,  the  increase  was  due  to 
greater  awareness  of  the  problem  of  overdose  deaths  and  to  improved  and  more 
frequently  used  laboratory  procedures.  For  example,  during  the  18  months  prior 
to  July  1970  drug  screens  were  performed  on  only  6.3  percent  of  all  autopsied 
deaths.  During  the  last  6  months  of  1970,  the  period  of  the  systematic  study, 
narcotic  drug  screens  were  performed  on  51  percent  of  all  autopsied  deaths.  ( See 
table  1. ) 

There  was  no  evidence  of  increasing  death  rates  over  the  6  months  of  the  study. 
Twenty-three  people  died  from  July  through  September,  and  19  died  from  October 
through  December  1970.  Thus,  although  the  time  span  was  short,  and  the  numbers 
were  small,  the  Washington  heroin  addiction  epidemic  may  have  stabilized  during 
the  last  6  months  of  1970.  Data  collection  is  continuing  and  in  the  next  year  more 
definitive  conclusions  should  be  possible. 

By  January  1971,  a  private  drug  treatment  program  located  in  the  District  of 
Columbia,  the  Blackman's  Development  Center  (BDC)  which  made  small  doses 
of  methadone  available  to  addicts  as  part  of  a  voluntary  outpatient  withdrawal 
program,  had  registered  over  20,000  "drug  dependents" — almost  all  heroin  addicts. 
Some  BDC  clients  lived  in  the  Washington  suburbs,  which  have  almost  no  treat- 


168 

ment  facilities  for  heroin  addicts.  However,  it  seems  unlikely  that  the  suburbs 
contributed  more  than  10  to  20  percent  of  BDC  registrants.  Thus,  even  when  the 
BDC  registration  list  is  discounted  for  suburban  residents,  nonheroin  users  and 
multiple  registrations  for  the  same  person,  the  20,000  figure  suggests  that  there 
are  many  more  thousands  of  addicts  in  Washington  than  the  1968  list  of  the 
Bureau  of  Narcotics  and  Dangerous  Drugs  indicated. 

There  are  other  figures  which  indicate  that  the  addiction  problem  is  greater 
than  had  previously  been  estimated.  The  Washington,  D.C.,  Metropolitan  Police 
Department  reported  4,730  narcotics  arrests  during  1970.  Ninety  percent  of  these 
arrests  related  to  heroin  use  or  sale.  The  numbers  of  narcotic  arrests  for  each 
year  from  1967  through  1969  were  818,  1,077  and  1,716  respectively.  Thus,  there 
was  a  462  percent  increase  in  narcotics  arrests  from  1967  to  1970.  Undoubtedly, 
part  of  this  increase  reflects  improved  and  increased  police  activity.  However,  it 
also  reflects  the  spreading  epidemic  of  heroin  addiction. 

Evidence  for  increasing  the  estimate  of  the  total  number  of  heroin  addicts  in 
Washington  comes  from  several  relatively  independent  sources.  These  include 
the  rate  of  commitment  of  narcotics  offenders  to  the  jail,  the  rate  of  opioid  over- 
dose deaths,  and  the  rate  of  narcotics  arrests.  More  direct  evidence  comes  from 
the  universal  experience  of  Washington  heroin  addiction  treatment  programs 
which  report  large  numbers  of  registrants. 

No  one  piece  of  evidence  is  conclusive.  However,  taken  together,  the  data  form 
a  pattern  which  clearly  indicates  that  the  number  of  heroin  addicts  in  Washing- 
ton is  far  higher  than  earlier  estimates.  Tlie  evidence  also  suggests  that  there 
has  been  a  major  increase  in  the  prevalence  of  heroin  addiction  in  the  last  several 
years. 

What  are  the  characteristics  of  the  addict  population? 

In  February  1970,  Washington  began  a  large  multimodality  treatment  program, 
the  Narcotics  Treatment  Administration.  By  January  14,  1971,  there  were  2,793 
heroin  addicts  in  treatment  in  the  NTA  programs. 

Study  of  the  77  onioid  overdose  deaths  in  1969  and  1970  revealed  demographic 
characteristics  of  the  group  on  the  four  basic  variables  of  age,  sex,  race,  and 
place  of  residence  in  the  city.  This  population  was  then  compared  to  the  NTA 
patient  population  using  these  same  four  variables.  The  results  are  shown  in 
figures  1  and  2. 

There  was  a  close  correspondence  betAveen  these  two  populations.  This  sup- 
ported the  assumption  that  NTA  was  reaching  typical  addicts  and,  unlike  vir- 
tually all  other  drug  programs  in  the  country,  the  treatment  population  was 
generally  representative  of  the  total  Washington  addict  population. 

Some  of  the  basic  characteristics  of  this  population  are  shown  in  table  2. 

When  did  the  epidemic  of  heroin  addiction  tegin? 

Assuming  that  the  NTA  patient  population  is  representative  of  the  total  Dis- 
trict of  Columbia  addict  population,  it  is  possible  to  determine  when  the  heroin 
addiction  began  for  Washington  addicts.  (See  fig.  3.) 

Fifty^two  percent  of  the  Washington  addicts  began  heroin  use  after  1965  and 
65  percent  began  after  1963.  This  data  indicates  that  the  epidemic  began  between 
1964  and  1966  and  became  increasingly  widespread  at  least  through  1968. 

The  individual  who  has  become  addicted  only  recently  is  often  less  motivated 
to  seek  treatment  for  his  addiction  since  he  is  still  enjoying  the  "high"  of  the 
drug  and  has  experienced  relatively  little  of  the  pain  and  danger  of  addiction. 
Thus,  most  treatment  programs  have  an  overrepresentation  of  older,  more  chronic 
addicts.  This  reluctance  of  the  newer  user  to  seek  help  probably  explains  the 
sharp  drop  in  the  number  of  addict  patients  who  began  use  during  1969  and 
1970.  However,  it  seems  certain  that  the  rise  in  addiction  between  1964  and  1968 
reflects  a  serious  epidemic  of  heroin  addiction  in  Washington.  This  is  corro- 
borated by  a  recent  study  of  the  rate  of  commitment  of  known  addicts  to  the 
District  of  Columbia  jail  between  1958  and  1968  which  shows  a  sharp  increase 
occurred  in  1967  (4).  (See  fig.  4.)  This  increase  also  corresponds  to  a  sharp  rise 
in  reported  serious  crimes  in  Washington  in  1966.  ( See  fig.  5. ) 

A  recent  St.  Louis  study  (5)  suggests  that  the  list  of  the  Bureau  of  Narcotics 
and  Dangerous  Drugs  of  known  heroin  addicts,  which  is  derived  primarily  from 
police  data,  generally  offers  a  good  estimate  of.  total  number  of  addicts  in  a 
community  when  the  total  is  stable.  The  data  may  not  be  reliable,  however,  in 
a  community  which  is  experiencing  a  sudden  epidemic  of  heroin  addiction.  The 
District  of  Columbia  jail  study  showed  that  there  is  a  substantial  time  lag  be- 
tween beginning  addiction  and  coming  to  the  jail.  For  example,  the  average 


169 

period  of  addiction  prior  to  the  current  incarceration  was  7  years  (1).  Ttiere- 
fore,  the  discrepancy  between  the  St.  Louis  data  and  the  District  of  Columbia 
data  may  reflect  the  acute  epidemic  in  Washington  in  recent  years.  This  hypo- 
thesis gains  some  support  from  the  fact  that  the  BNDD  list  for  Washington  rose 
sharply  from  about  1,100  each  year  from  1965  through  1968  to  1,743  by  December 
31,  1970.  The  earlier  BNDD  figures  for  Washington  for  1965  through  1969  were: 
1,116, 1,164, 1,106, 1,162,  and  1,636. 

Where  do  heroin  addicts  live  in  the  city? 

Based  on  the  opioid  overdose  deaths  and  NTA  patients,  and  assuming  that 
there  are  a  total  of  16,800  heroin  addicts  in  the  city,  it  is  possible  to  describe  a 
geographic  profile  of  addiction  in  the  city. 

( See  table  3  and  fig.  6. ) 

The  rates  of  heroin  addiction  range  from  less  than  0.1  percent  for  the  rela- 
tively affluent  northwest  section  of  the  city  west  of  Rock  Creek  Park,  to  the  rate 
of  4  percent  in  the  model  cities  area,  area  6.  These  rates  of  addiction  closely 
parallel  reported  crime  rates  and  other  indicators  of  poverty  and  social 
disorganization. 

(See  table  4.) 

Using  this  same  data  it  is  possible  to  estimate  the  number  of  addicts  per 
thousand  people  in  various  sex  and  age  groups  in  the  Washington,  D.C., 
population. 

From  statistics  based  on  opioid  deaths,  several  conclusions  can  be  drawn. 
Addiction  is  concentrated  almost  exclusively  between  the  ages  of  15  and  45. 
Sixty^five  percent  of  the  addicts  are  under  26  and  31  percent  are  younger  than 
21  years  of  age.  For  the  age  range  15  through  19,  the  citywide  rate  for  boys  is 
10.7  percent  and  for  girls  2.2  percent.  The  next  older  age  bracket,  20  through  24, 
has  rates  of  19.8  percent  and  3.2  percent  respectively  for  boys  and  girls.  From 
25  through  29,  the  rates  are  6.2  and  5.0. 

( See  fig.  7  and  table  5. ) 

Relating  this  data  to  the  geographic  distribution  data  and  using  the  distribu- 
tion of  NTA  patients  indicates  that  in  service  area  6  (the  model  cities  area)  20 
percent  of  the  boys  between  the  ages  of  15  and  19,  and  an  astonishing  38  percent 
of  the  young  men  between  the  ages  of  20  and  24  are  heroin  addicts.  The  District 
of  Columbia  model  cities  area  begins  six  blocks  north  of  the  White  House,  and 
extends  east  above  Massachusetts  Avenue  to  four  blocks  north  of  the  U-S. 
Capitol. 

How  much  does  the  heroin  addiction  epidemic  cost  the  community? 

The  most  certain  and  tragic  cost  of  heroin  addition  in  1970  was  the  63  people 
who  died  of  opioid  overdoses.  In  addition,  almost  all  heroin  addicts  commit 
crimes  to  support  their  expensive  habits.  Based  on  an  estimate  of  15,0(X)  heroin 
addicts,  and  assuming  an  average  habit  of  $40  per  day,  a  recent  study  estimated 
that  the  annual  value  of  proijerty  and  services  transferred  because  of  addiction 
through  robbery,  theft,  prostitution,  drug  sales,  et  cetera,  was  $328,100,000  (6). 
One  of  the  common  ways  to  support  a  habit  is  to  sell  heroin.  This  spreads  the 
epidemic.  The  indirect  costs  of  heroin  addiction  to  the  community  from  urban 
disorganization  and  fear  of  crime  are  equally  staggering. 

What  can  be  done  about  the  epidemic? 

Heroin  addiction  is  a  treatable  disease  for  most  addicts.  There  is  excellent 
evidence  that  methadone  maintenance  is  safe  and  effective  (7).  Therapeutic  com- 
munities (such  as  Synanon,  Day  top,  and  Phoenix  House)  and  community  self- 
help  organizations  (such  as  Blackman's  Development  Center  in  Washington) 
offer  promise  of  success  with  many  addicts. 

A  recent  study  of  the  narcotics  treatment  administration  program  perform- 
ance with  475  randomly  selected  patients  for  the  6-month  period  from  May  15 
through  November  15,  1970,  showed  that  55  percent  of  all  patients  in  the  program 
on  May  15  were  still  in  the  program  6  months  later.  The  retention  rate  for  high 
dose  methadone  maintenance  was  86  percent  after  6  months.  Arrest  rates  were 
down  and  employment  was  up  for  the  patient  population.  Only  7  percent  of  the 
patient  population  was  still  regularly  using  illegal  drugs  and  55  percent  showed 
no  evidence  of  illegal  drug  use  during  the  sixth  month  of  treatment  (S). 

Seventy -six  percent  of  NTA  patients  were  voluntary,  self -referred  walk-ins 
to  one  of  the  10  NTA  centers  located  throughout  the  city.  Twenty-four  percent 
were  referred  by  agencies  of  the  criminal  justice  system,  such  as  probation  and 

60-296  O— 71— pt.  1 12 


170 

parole  departments.  None  were  civilly  committed.  About  100  lived  in  three  NTA 
halfway  houses.  Seventy  were  residents  almost  always  for  less  than  3  weeks,  on 
two  NTA  detoxification  wards  at  District  of  Columbia  General  Hospital.  The 
remainder,  about  2,600,  were  outpatients.  Fifty-four  percent  were  receiving 
methadone  maintenance,  26  percent  were  in  abstinence  programs,  and  20  percent 
were  receiving  decreasing  doses  of  methadone  leading  to  abstinence. 

The  unprecedented,  sharp  dip  in  the  rate  of  serious  crimes  in  Washington 
during  1970  (see  fig.  5)  was  widely  attributed  to  increased  police  presence  and 
particularly  to  the  effectiveness  of  the  NTA  treatment  programs  (9) . 

How  much  do  treatment  progrwms  cost? 

An  economic  study  of  drug  addiction  demonstrates  that  if  NTA  can  suc- 
cessfully treat  only  40  percent  of  1,000  patients  (a  low  estimate  on  the  basis  of 
performance  studies)  the  cost  of  treatment  for  1  year  will  be  $1,400,000.  The 
benefits  in  terms  of  reduced  criminal  activity  will  be  $5,750,770.  This  shows  a 
benefit-cost  ratio  of  4.1  to  1  (6). 

On  January  14,  1971,  when  NTA  had  2,793  patients,  the  total  cost  »f  the  pro- 
gram was  less  than  $4  million  a  year. 

References 

(1)  Kozel,  N.,  Brown,  B.,  DuPont,  R. :  "Narcotics  and  crime:  a  study  of  narcotics 

involvement  in  an  offender  population."  Narcotics  Treatment  Administra- 
tion, 1971. 

(2)  Glendinning,   S. :   "District  of  Columbia  coroner's  office  study."  Narcotics 

Treatment  Administration,  1970. 

(3)  Johnston,  E.   H.,  Goldbaum,  R.,  Welton,  R.  L. :   "Investigation  of  sudden 

deaths  in  addicts."  Medical  Annals  of  the  District  of  Columbia,  38:  375- 
380,  1969. 

(4)  Adams,  S.,  Meadows,  D.  F.,  Reynolds,  C.  W. :  "Narcotic-involved  inmates  in 

the  Department  of  Corrections."  District  of  Columbia  Department  of  Cor- 
rections Research  Report  No.  12, 1969. 

(5)  Robins,  L.  N.,  Murphy,  G.  E. :  "Drug  use  in  a  normal  population  of  young 

Negro  men."  Am.  J.  Publ.  Hlth.,  57  :  1580-1596, 1967. 

(6)  Holahan,  J. :  "The  economics  of  drug  addiction  and  control  in  Washington, 

D.C. :  a  model  for  estimation  and  costs  and  benefits  of  rehabilitation." 
Special  Report  by  the  Office  of  Planning  and  Research  of  the  District  of 
Columbia  Department  of  Corrections,  1970. 

(7)  Gearing,  F.  R. :  "Successes  and  failures  in  methadone  maintenance  treatment 

of  heroin  addition  in  New  York  City."  Presented  at  the  Third  National 
Conference  on  Methadone  Treatment,  Nov.  14, 1970. 

(8)  Brown,  B.  S.,  DuPont,  R.  L. :  "6-month  followup  of  heroin  addicts  in  a  large 

multimodality  treatment  program."  Narcotics  Treatment  Administration, 
1971. 

(9)  DuPont,  R.  L. :  "Urban  crime  and  the  rapid  development  of  a  large  heroin 

addition  treatment  program."  Presented  at  the  Third  National  Conference 
on  Methadone  Treatment,  Nov.  16,  1970,  accepted  for  publication  in  J.  Am. 
Med.  Assoc,  1971. 

Table  1. — The  number  of  opioid  overdose  deaths  each  month  from,  July  through 

December  1970 

July  9 

August 5 

September 9 

October 8 

November 7 

December 4 

Total  42 

Average  per  month 7 


171 


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172 

Table  2. — Selected  characteristics  of  the  NT  A  patient  population  (N=2T59) 

Percent 

Reporting  regular  heroin  use  prior  to  treatment 99 

Average  number  of  arrests  reported  prior  to  treatment 4.  7 

Average  number  of  convictions  reported  prior  to  treatment 1.  7 

First  drug  used : 

Heroin 9 

Marihuana 49 

Heroin  and  marihuana  in  same  year 7 

Other 35 

Average  age  at  first  heroin  use 19 

"Voluntary  admissions 76 

Referred  from  agencies  of  the  criminal  justice  system 24 

Civilly  committed 0 

Reporting  prior  treatment  for  heroin  addiction 41 

Martial  status : 

Single   58 

Married 23 

Separated 13 

Divorced 4 

Widowed  or  deserted 2 

Last  year  of  school  completed,  average 10.  4 

Receiving  welfare  at  start  of  treatment 7 


173 


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174 


TABLE  3.— HEROIN  ADDICTION  RATES  BY  SERVICE  AREA 


Heroin  overdos 

e  deaths 

from  April  through 

NTA  clients  (random 

Estimated 

Number 

November, 

1970 

sample 

of  500) 

total 
number 

of  addicts 
per  1,000 

Number 

Percent 

Number 

Percent 

of  addicts  1 

population  2 

3 

6.5 

33 

6.6 

1,109 

13.3 

0 

0 

17 

3.4 

571 

10.9 

6 

13.0 
19.6 

55 
62 

11.0 
12.4 

1,848 
2,083 

19.9 

9 

18.0 

4 

8.7 

71 

14.2 

2,385 

27.7 

13 

28.3 

121 

24.2 

4,066 

40.2 

10 

21.7 

121 

24.2 

4,066 

30.8 

0 

0 

2 

0.4 

67 

0.8 

1 

2.2 

18 

3.6 

605 

14.6 

Service  area 

1 

2 

3 

4 

5 

6 

7 

8. 

9. 

Total 


46 


100 


500 


100 


16,800 


21.2 


1  Based  on  16,800  estimate  of  total  number  of  addicts  distributed  according  to  percent  of  NTA  patients  or  service  area. 

2  Based  on  16,800  estimate  of  total  heroin  addicts  and  distributed  according  to  percent  of  NTA  patients  by  service  area. 


Note.— Service  area  population  used  were  1967  estimates. 


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TABLE  5.— CITYWIDE  HEROIN  ADDICTION  RATES  BY  AGE-SEX  GROUPINGS  i 

(In  percent] 


Males 


Females 


Total 


15tol9 12.9  2.0  7.1 

20to24.... 18.9  3.0  10.5 

25to29 _ 6.3  4.7  5.5 

30to34 5.4  3.4  4.4 

35to39 4.3  .9  2.5 

40to44 2.5  .7  1.5 

45  to  49 

50  to  54 _.. .7  .4 


'  Based  on  1968  population  statistics,  age-sex  distributions  of  91  overdose  deaths  (August  1968  through  November  1970), 
and  total  estimated  addict  population  of  16,800. 


177 


Number  In 
Thousands 

40 

38 
36 
34 
32 

30 
28 
26 
24 
22 
20 
18 
16 
14 
12 
10 

8 

6 

4 

2 

0 


FIGURE    FIVE 


CRIME  INDEX  OFFENSES 
1959  THRU  1970 

SIX  MOKTH  TOTALS 


' 

■ 

'■       \       \        '       •                                            1 

— 

!" 

' 

-— 

CRIME  INDEX  OFFENSES 
Murder 
Rape 
Robbery 
Agg.  Assault 
Burglary 

Larceny  (over  $50) 
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DEC  JUN  DEC  JUN  DEC  JUN  DEC  JUN  DEC  JUN  DEC  JUN  DEC  JUN  DEC  JUN  DEC  JUN  DEC  JUN  DEC  JUN  DEC  JUN  DEC 

58         59  60  61  62  63  64  65  66  67  68  69 


D.  C.  SERVICE  AREAS 

AND 

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CENSUS  TRACTS 

PREPARED  BY  THE    D  C    GOVERNMENT 
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[Exhibit  No.  11(b)] 

GOVEBNMENT  OF  THE   DiSTBICT   OF  COLUMBIA,    NABCOTICS   TbEATMENT 

Administbation,  Office  of  the  Dieectob,  Washington,  D.C. 

Januaby  12,  1971. 

SUMMAEY   of    6-MONTH   FOLLOWTJP   STUDY 

There  were  1,060  heroin  addict  patients  in  treatment  with  the  Narcotics  Treat- 
ment Administration  on  May  15, 1970.  iSix  hundred  and  twenty-five  (625)  of  these 
were  randomly  selected  and  followed  for  6  months  by  the  Research  and  Develop- 
ment Division  of  the  NTA. 

The  Youth  Division  of  NTA  differed  significantly  from  the  adult  programs  and 
is  therefore  considered  separately. 

There  were  475  patients  in  the  adult  program  sample  on  May  15,  1970.  Six 
months  later,  on  November  15,  1970,  217  (46  percent)  of  these  people  were  still 
active  and  reportable*  with  their  original  NTA  program.  In  addition,  43  (9  per- 
cent) were  active  and  reportable  in  other  NTA  programs  into  which  they  had 
transferred.  Thus,  a  total  of  55  percent  of  the  clients  reportable  to  NTA  as  of 
May  15  remained  reportable  to  NTA  6  months  later  (table  1).  Eighty -nine  (19 
percent)  of  these  475  had  been  arrested  for  a  new  charge  during  the  6  months 
followup  period. 

The  highlights  of  this  followup  study  are  reported  in  tables  1  through  4. 

It  is  noteworthy  that  there  is  a  much  higher  retention-in-program  rate  in  high 
dose  methadone  treatment  than  in  other  treatment  classifications  (table  1). 

The  high  dose  methadone  group  not  only  achieves  this  high  retention  rate  (86 
percent) ,  but  also  has  the  lowest  arrest  rate  (12  percent)  (table  2) . 

The  arrest  data  was  also  examined  comparing  the  arrest  rate  of  individuals  in 
the  NTA  programs  with  the  arrest  rate  of  those  who  left  the  program.  The  former 


♦A  patient  Is  "reportable"  If  he  has  been  seen  at  least  four  times  In  the  14  consecutive 
calendar  days  preceding  the  weekly  NTA  census. 


179 

had  an  arrest  rate  of  2.8  percent  per  patient-month  of  treatment  while  the  latter 
(the  dropouts)  had  an  arrest  rate  of  5.7  percent  per  month  after  leaving  the 
program. 

Table  3  reports  arrest  rates  after  6  months  in  the  community  for  heroin  addicts 
released  from  the  Department  of  Corrections  before  the  start  of  NTA  in  1970. 
This  table  is  included  for  comparison  purposes. 

Tables  4  and  5  contain  data  on  employment  rates  and  dirty  urine  rates.  Both 
are  encouraging  but  suggest  the  need  for  increased  counseling  and  job  placement. 

The  150  patients  in  the  youth  program  fared  less  well  (see  client's  functioning 
in  the  Youth  Division  programs — ^May  15,  1970 — Nov.  15,  1970).  Only  1  percent 
of  these  youths  received  methadone  maintenance  treatment  while  an  additional 
10  percent  received  either  methadone  detoxification  or  emergency  short-term 
methadone  treatment  (methadone  hold).  Thus  89  percent  of  the  sample  never 
received  methadone.  Forty-two  percent  of  the  youth  clients  were  arrested  during 
the  course  of  the  6-month  followup.  Sixty  of  the  150  youths  remained  in  the  pro- 
gram after  6  months  (40  percent  retention  rate)  but  only  18  of  these  were  still 
giving  regular  urine  samples  (12  percent  of  150). 

The  results  of  the  Youth  Division  program  were  generally  similar  to  the 
results  of  the  abstinence  programs  for  adults.  The  results  of  the  abstinence  pro- 
grams are  not  as  encouraging  as  the  results  from  high  dose  methadone  mainte- 
nance treatment.  However,  it  must  be  emphasized  that  while  there  were  many 
failures  in  the  abstinence  programs  there  were  at  least  a  few  apparent  suc- 
cesses— for  example  while  42  percent  of  the  youths  were  arrested  during  the  6 
months  followup,  58  percent  were  not  arrested. 

This  summary  relates  to  NTA's  performance  with  patients  who  were  in  the 
program  from  May  15  through  November  15,  1970.  'Since  May  15,  there  have  been 
some  improvements  in  our  programs  and  a  great  enlargement.  On  January  8, 1971, 
NTA  had  2,670  reportable  patients.  Of  this  total  1,402  receiving  methadone  main- 
tenance treatment,  526  were  on  methadone  detoxification,  and  35  were  on  emer- 
gency doses  of  methadone  (methadone  hold).  Thus  1,963  (74  percent)  were 
receiving  methadone  and  707  (26  percent)  were  abstinent. 


180 


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183 

[Exhibit  No.  11(c)] 
Dr.  DuPont's  Numbers 

Of  1,060  patients  in  NTA  on  May  15,  1970,  450  were  randomly  selected  for 
foUowup. 

Of  these  450,  56  percent  remained  in  the  program  for  6  months,  and  40  per- 
cent remained  for  11  months. 

Of  those  on  methadone  maintenance,  86  percent  remained  6  months  as  com- 
pared to  15  percent  who  received  no  methadone  (or  were  abstinent). 

After  11  months,  22  percent  of  the  450  were  rearrested.  Of  the  people  who  re- 
mained in  the  program,  13  percent  were  rearrested.  Of  those  who  dropped  out, 
28  percent  were  rearrested  in  11  months. 

In  the  last  8  months,  23  people  have  died  of  overdoses  with  methadone.  Only 
five  of  these  got  their  methadone  from  NTA. 


[Exhibit  No.  11(d)] 
Administration  Order 

1.  purpose 

The  purpose  of  this  administration  order  is  to  provide  medical  and  program 
guidelines  for  methadone  treatment  in  Narcotics  Treatment  Administration  pro- 
grams and  cooperating  programs. 

2.  DEFINITIONS 

New  admissions  are  persons  who  have  no  previous  record  in  Information 
Central. 

Readmissions  have  l)een  previously  known  by  NTA  central  information  but 
their  cases  have  been  deactivated. 

Reportable  patients  are  defined  as  patients  who  have  been  seen  at  least  four 
times  in  the  preceeding  14  consecutive  calendar  days. 

Reportable  patients  will  be  considered  to  be  in  one  of  the  following  four 
categories : 

1.  Abstinence 

2.  Methadone  maintenance 

3.  Methadone  detoxification. 

4.  Methadone  hold. 

Nonreportahle  patients  are  seen  at  least  once  in  the  preceding  28  days  but  do 
not  qualify  as  reportable. 

Transfers  are  any  patients  known  to  Information  Central  who  undergo  an 
approved  change  in  treatment  centers. 

Inactive  patients  are  defined  as  those  who  have  no  face-to-face  contact  during 
the  preceding  28  days. 

Abstinence  is  defined  as  any  continuing  treatment  contact  with  the  Narcotics 
Treatment  Administration  program  or  cooperating  program  in  which  the  indi- 
vidual patient  does  not  receive  methadone. 

Methadone  maintenance  is  a  treatment  classification  to  be  used  for  all  pa- 
tients who  receive  regular  doses  of  methadone  when  the  dose  of  methadone  is 
not  consistently  reduced.  That  is,  any  patient  who  receives  a  regular  dose  of 
methadone  at  the  same  dose  level  or  increasing  dose  level  is  to  be  considered 
a  methadone  maintenance  patient.*  All  patients  in  the  methadone  maintenance 
category  should  be  urged  to  stay  on  methadone  maintenance  until  their  life 
situations  have  been  stabilized  for  a  period  of  6  months  to  1  year  or  longer.  Any 
patient  who  comes  off  methadone  maintenance  should  be  strongly  urged  to  stay 
in  the  treatment  program  while  he  is  being  detoxified  and  after  he  is  abstinent 
for  a  period  of  not  less  than  2  months.  During  this  time,  urine  testing  and  coun- 
seling should  continue  while  the  patient  is  considered  an  "abstinence  patient." 
If  there  are  signs  of  renewed  drug  hunger  and  the  patient  feels  he  cannot  con- 
trol this  urge,  or  if  there  are  signs  of  renewed  drug  use,  the  patient  should  be 


*  The  only  exceptions  to  this  definition  are  the  special  youth  detoxification  schedules 
which  have  a  period  of  Increasing  doses,  a  plateau,  and  a  programed  detoxification  within 
6  months  of  the  first  dose. 


184 

encouraged  to  return  to  methadone  maintenance  treatment  for  another  pro- 
longed period  of  time.  Experience  has  shown  that  patients  who  stop  meihadone 
mamteuance  have  a  high  relapse  rate,  especially  it  ihey  have  been  on  the  metha- 
done maintenance  program  less  than  a  year.  Therefore,  every  effort  shuula  be 
made  on  the  part  of  program  staff  to  retain  patients  in  continuing  treatment  for 
a  period  of  weeks  or  months  after  the  patient  begins  a  detoxification  program. 
Patients  in  methadone  maintenance  should  be  treated  with  regular  doses  of 
methadone  between  SO  and  120  milligrams  a  day.  Dose  levels  less  than  SO  mini- 
grams  are  discouraged  because  of  the  likelihood  of  continued  drug  abuse.  Doses 
above  120  milligrams  are  to  be  discouraged  because  it  is  unlikely  that  they  will 
produce  additional  benefits  to  the  patient.  Under  no  circumstances  are  patients 
to  be  given  more  than  150  milligrams  of  methadone  a  day. 

Methadone  detoxification  should  in  no  circumstances  be  prolonged  for  more 
than  3  months.  A  patient  on  detoxification  should  not  receive  more  than  50  milli- 
grams a  day  unless  he  is  being  detoxified  from  methadone  maintenance.  The 
physician  in  charge  of  the  patient's  treatment  should  establish  a  schedule  for 
gradually  decreasing  doses  with  abstinence  to  be  achieved  between  2  weeks  and 
3  months  after  the  start  of  methadone  detoxification.  Urine  results  must  be 
monitored  carefully  in  this  group  because  of  a  strong  likelihood  that  they  will 
experience  renewed  drug  hunger  and  return  to  illegal  drug  use,  particularly  at 
dose  levels  below  40  milligrams  a  day.  Evidence  of  renewed  illegal  drug  use  or 
drug  craving  beyond  the  individual  patient's  ability  to  control  it  are  indications 
for  the  patient's  going  on  methadone  maintenance.  Under  no  circumstances 
should  a  person  be  classified  as  methadone  detoxification  for  more  than  3  months. 
Methadone  hold  patients  are  classified  in  this  group  if  they  are  given  doses  of 
methadone  on  an  emergency  basis  prior  to  appropriate  examination,  diagnosis 
and  disposition.  Under  no  circumstances  should  a  patient  be  retained  in  the 
methadone  hold  category  for  more  than  2  weeks. 

Authorized  medical  representatives.  Only  physicians  can  sign  prescriptions. 
Others,  including  nurses,  medical  assistants  etc.,  may  dispense  methadone  and 
sign  NTA  Form  6  (attachment  5). 

3.    POLICY 

Because  people  who  are  addicted  to  heroin  often  have  many  psychological  and 
vocational  problems  requiring  vigorous  and  effective  treatment,  IsTA's  goal  for 
each  patient  is  social  rehabilitation.  Methadone  treatment  must  be  considered 
within  this  context  as  only  one  part  of  the  total  treatment  program. 

The  heroin  addict  patient  may  suffer  from  a  number  of  medically  treatable 
illnesses  and  for  each  of  these,  of  course,  the  appropriate  medical  treatment  is 
indicated.  For  example  the  heroin  addict  may  have  clinical  schizophrenia  with 
the  common  symptoms  of  that  illness.  In  this  case,  the  most  appropriate  medical 
treatment  includes  a  phenothiazine. 

Nevertheless,  the  only  drug  that  has  been  shown  to  be  useful  in  the  treatment 
of  heroin  addiction  itself  is  methadone.  Therefore,  no  other  drug  should  be 
prescribed  for  treatment  of  heroin  addiction.  For  example,  there  is  no  evidence 
that  tranquilizers  or  hypnotics  are  useful  in  the  treatment  of  heroin  addiction 
or  heroin  withdrawal.  Furthermore,  these  drugs  are  specifically  contraindicated 
in  the  treatment  of  heroin  addicts  since  they  are  likely  to  become  drugs  of 
abuse  in  their  own  right.  This  is  particularly  true  of  the  hypnotics  (such  as 
Seconal  and  doriden)  but  it  is  also  true  of  the  antianxiety  tranquilizers  (such 
as  librium  and  meprobamate).  The  heroin  addict  has,  in  part,  gotten  himself 
in  serious  trouble  because  of  his  tendency  to  medicate  himself  and  to  treat 
his  unpleasant  feelings  with  a  variety  of  drugs,  especially  heroin.  Therefore, 
the  physician  dealing  with  heroin  addicts  can  anticipate  requests  from  the  addict 
for  medications  of  all  kinds.  The  doctor  should  be  armed  with  the  knowledge 
that  no  tranquilizer  or  hypnotic  has  been  shown  to  be  useful  in  the  treatment 
of  heroin  addiction.  He  should  share  this  information  with  the  patient.  How- 
ever, the  physician  should  avoid  routine  use  of  either  type  of  drug.  The  physician 
should  never  prescribe  these  drugs  for  more  than  a  few  days  because  of  the 
likelihood  of  producing  dependence  on,  or  even  addiction  to,  these  drugs. 

Meth<idone  maintenance,  on  the  other  hand,  has  been  demonstrated  to  be 
effective  in  achieving  specific  results.  The  primary  drug  result  is  blocking  the 
"drug  craving"  which  usually  occurs  at  a  dosage  of  about  40  to  50  milligrams 
a  day.  When  maintenance  levels  reach  about  100  milligrams  a  day,  there  is 
an  additional  important  drug  effect :  the  suppression  of  euphoria  from  intra- 


185 

venously  administering  heroin.  These  are  the  two  effects  that  are  most  desirable 
in  the  use  of  methadone  maintenance  for  chronic  heroin  addiction.  Methadone 
maintenance  does  not  produce  the  suppression  of  all  anxiety,  depression,  or 
other  uncomfortable  bodily  feelings.  Neither  the  addict  nor  the  doctor  should 
expect  these  results. 

Methadone  in  adequate  doses,  blocks  the  drug  hunger  for  heroin  and  the 
high  of  heroin.  It  does  not  alter  other  forms  of  drug  abuse.  Therefore,  the 
clinician  should  be  watchful  for  signs  of  other  drug  abuse  such  as  amphetamine, 
barbiturate,  and  most  especially  alcohol  abuse.  Each  of  these  conditions  is  serious 
and  requires  prompt,  appropriate,  and  vigorous  treatment. 

4   PR0CE3)URES 

Methadone  may  be  used  in  three  treatment  categories :  methadone  mainte- 
nance, methadone  detoxification,  and  methadone  hold.  The  following  are  in- 
dividual discussions  of  each : 

I.  Methadone  Maintenance 

A.  Indications  for  methadone  maintenance 

The  indications  for  methadone  maintenance  are : 

1.  The  patient  volunteers  for  methadone  maintenance; 

2.  The  patient  has  used  heroin  continuously  for  at  least  one  (1)  year ; 

3.  The  patient  is  at  least  eighteen  (18)  years  old.  (Exceptions  to  this 
ruling  are  discussed  in  section  I,  I.  Methadone  Maintenance  Treatment  for 
Youth.) 

B.  Preparing  the  patient  for  methadone  maintenance  treatment 
Methadone  maintenance  treatment  is  entirely  voluntary  for  all  patients.  No 

one  should  be  forced  or  coerced  into  methadone  maintenance.  If  the  patient  ex- 
presses the  desire  to  go  on  methadone  maintenance,  the  implications  of  treat- 
ment must  be  carefully  and  completely  explained  to  him. 

Prospective  methadone  maintenance  patients  should  be  encouraged  to  think 
of  it  as,  at  least,  a  6-month  commitment  to  continue  the  treatment.  For  most 
patients  it  makes  sense  to  continue  methadone  maintenance  for  years  until 
their  social,  psychological,  and  biological  life  has  been  satisfactorily  stabilized. 
The  preliminary  results  of  our  investigations  into  program  performance  indi- 
cate that  the  premature  discontinuance  of  methadone  maintenance  and  dose 
levels  under  80  milligrams  per  day  are  often  associated  with  the  patient's  re- 
turn to  heroin  addiction  and  criminal  behavior. 

C.  Consent  to  take  methadone  maintenance  treatment 

Before  beginning  methadone  maintenance  treatment,  each  patient  must  sign 
NTA  Form  19  "Informed  Consent  to  Take  Methadone  Treatment"  (see  attach- 
ment 1).  If  a  patient  is  under  21,  every  effort  should  be  made  to  get  either  a 
parent  or  guardian  signature  on  the  consent  form,  although  this  may  not  be 
possible  or  practical  in  every  case.  In  addition,  NTA  Form  7  (see  attachment 
2)  must  be  completed  on  each  patient  and  registered  with  Information  Central 
before  any  medication  or  treatment  services  are  provided. 

D.  Dose  level 

For  all  NTA  treated  patient's  receiving  methadone  maintenance  treatment, 
the  physician  should  attempt  to  give  a  "blocking"  dose  of  80  to  120  milligrams  a 
day.  There  is  good  reason  to  be'ieve  that  lower  doses  are  associated  with  signifi- 
cantly hisher  failure  rates  and  that  lower  doses  do  not  produce  any  advantage 
to  the  patient. 

Methadone  maintenance  programs  have  been  shown  to  be  effective  only  when 
methadone  is  used  in  a  specific  manner.  The  drug  is  given  to  the  patient  once 
a  day,  and  the  patient's  dose  is  modified  on  the  basis  of  his  response  to  the  medi- 
cation. The  initial  dose  level  should  be  moderate,  in  the  range  of  20  to  50 
milligrams. 

NTA  medication  schedules  (see  attachment  3)  provide  all  necessary  informa- 
tion for  raising  or  lowering  doses,  depending  on  the  treatment  indicated,  by  age, 
size  and  duration  of  habit,  et  cetera.  Since  the  duration  of  action  of  methadone  is 
24  to  48  hours,  the  drug  lends  itself  to  daily  administration. 

The  dose  level  should  be  increased  to  a  level  of  about  100  milligrams  a  day 
in  those  patients  who  can  tolerate  this  dose  level  without  excessive  drowsiness 

60-296  0-^71— pt.  1 13 


186 

or  other  side  effects.  This  increase  should  occur  gradually  over  a  3-  to  6-week 
period. 

Patients  are  not  to  be  told  their  dose  level  since  this  leads  to  an  unhealthy 
'"competition"  among  the  patients  for  the  highest  doses.  Dose  level  is  a  medical 
issue  and  it  should  be  managed  by  the  medical  staff. 

E.  Side  effects  of  methadone 

Side  effects  of  methadone  include  excessive  sweating,  constipation,  edema, 
drowsiness,  dermatitis,  and  relative  impotence  in  men.  None  of  these  symptoms 
are  serious,  and,  with  the  exception  of  excessive  sweating,  they  usually  disappear 
as  treatment  is  continued  and  tolerance  is  attained.  However,  some  patients  con- 
tinue to  suffer  from  constipation.  This  can  be  treated  symptomatically  with  a 
laxative,  but  even  this  is  usually  not  needed  once  a  tolerance  develops. 

F.  Take-home  medication 

Methadone  is  to  be  administered  to  the  patient  daily  (6  or  7  days  per  week 
depending  on  the  number  of  days  the  center  is  opened)  on  the  premises  of  an 
NTA  facility  for  the  first  3  months  of  his  treatment.  Once  the  patient's  drug 
use  has  ceased  for  at  Idast  1  month  and  he  has  demonstrated  stability  in  his  life 
patterns,  he  may  take  home  his  weekend  medication  at  the  discretion  of  the 
appointed  person  in  charge  and  after  signing  NTA  Form  22  "Statement  of  Re- 
sponsibility for  Take-Home  Medication"   (see  attachment  4). 

Individual  doses  to  take  off  NTA  premises  must  be  properly  labeled  with  the 
patient's  name,  the  date  the  dose  is  to  be  taken,  and  the  specific  program  name 
and  telephone  number.  The  label  must  also  state  that  the  bottle  contains  metha- 
done and  that  it  is  dangerous  and  may  be  fatal  if  taken  by  anyone  other  than  the 
patient. 

Patients  are  to  return  all  empty  bottles  before  new  bottles  are  given.  If  the 
patient  fails  to  return  his  bottle,  loses  or  breaks  it,  or  reverts  to  drug  use,  he  will 
be  required  to  report  in  daily  again  for  at  least  4  weeks. 

Because  methadone  may  be  fatal  when  taken  by  a  nonaddicted  person  in  doses 
conventionally  given  to  methadone  maintenance  patients,  patients  taking  medi- 
cation home  must  keep  it  in  the  locked  container  provided  by  the  center.  The 
fact  that  methadone  is  packaged  in  a  liquid  form  makes  it  particularly  attractive 
to  children.  The  patient  must  be  impressed  with  the  danger  involved  in  taking 
medication  home  and  be  strongly  encouraged  not  only  to  lock  up  his  methadone, 
but  to  place  it  out  of  children's  reach. 

In  addition,  the  patient  should  be  reminded  that  methadone  should  not  be 
refrigerated. 

G.  Urine  testing 

Every  methadone  maintenance  patient  must  submit  a  monitored  urine  speci- 
men a  minimum  of  once  a  week. 

These  urine  collections  must  be  monitored  by  an  NTA  staff  member  or  a  staff 
member  of  a  cooperating  program  under  the  general  direction  of  the  program 
chief.  Unmonitored  specimens  are  worthless  for  our  purposes  and  should  be 
discarded. 

All  staff  who  are  monitoring  urine  should  sign  the  urine  specimen  label  found 
on  the  back  of  NTA  form  6  (see  attachment  5).  These  staff  members  should  be 
trained  so  they  recognize  an  adequate  quantity  of  urine.  No  urines  should  be 
reported  back  from  the  laboratory  as  quantity  not  sufficient  (QNS)  :  the  staff 
should  discard  urines  of  inadequate  quantity. 

In  unusual  cases,  or  where  there  is  special  concern  about  the  possibility  of 
patients  continuing  to  use  illicit  drugs,  three  or  more  samples  a  week  may  be 
sent  to  the  laboratory  for  analysis. 

H.  Suspension  from  methadone  maintenance  program 

Patients  failing  to  report  for  treatment  for  30  consecutive  days  will  auto- 
matically be  suspended  from  treatment.  The  suspended  patient  will  have  to 
wait  30  days  before  he  is  eligible  for  treatment  or  the  waiting  list  again. 

If  the  center  physician  and/or  the  center  administrator  suspends  a  patient 
before  30  consecutive  days  without  treatment  have  elapsed,  the  physician  or 
administrator  must  complete  NTA  form  0  "Report  of  Pntirvt  Chnnor  of  Status" 
(see  attachment  6) 'and  send  it  to  Information  Central.  Tr^  this  case,  the  patient 
will  not  be  accepted  back  into  treatment  or  placed  on  the  waiting  list  for  30  days 
after  the  suspension  date. 


187 

I.  Methadone  maintenance  treatment  for  youth 

For  purposes  of  treatment  planning  (as  opposed  to  legal  considerations  re- 
garding consent)  patients  are  considered  adults  if  they  are  18  or  over. 

Individuals  who  are  less  than  18  may  receive  methadone  on  short  or  long 
detoxification  schedules  (none  longer  than  6  months)  after  notifying  the  director 
of  NTA. 

In  the  future,  NTA  may  try  an  experimental  maintenance  program  for  youth 
under  18  but  our  experience  is  too  limited  to  make  a  final  decision  on  that  issue 
at  this  time. 

II.  Outpatient  Methadone  Detoxification 

A.  Eligibility 

Outpatient  methadone  detoxification  should  be  attempted  with  the  following : 

1.  Any  patient  who  has  a  history  of  less  than  1  year  addiction  to  heroin ;  or 

2.  Any  patient  who  is  under  18  years  of  age ;  or 

3.  Any  patient  who  requests  this  treatment. 

B.  Dose  level 

Methadone  detoxification  should  begin  by  "catching"  the  addict's  habit,  usual- 
ly with  doses  in  the  range  of  20  to  50  milligrams  per  day.  ( See  medication  sched- 
ules, attachment  3.) 

Initially,  this  may  require  doses  more  than  once  a  day  until  the  proper  dose 
level  is  achieved  so  that  the  patient  does  not  experience  vdthdrawal  symptoms 
(too  little  methadone)  or  excessive  drowsiness  (too  much  methadone).  This 
holding  dose  should  then  be  reduced  very  gradually  over  a  2  to  12-week  period. 
Drug  hunger  should  be  anticipated  at  dosages  of  less  than  40  milligrams  per  day. 

C.  Urine  testing 

Regular  urine  testing  and  monitoring  should  be  followed  as  in  the  methadone 
maintenance  program.  ( See  section  I,  A  for  details. ) 

Reemergence  of  regular  heroin  use  is  a  sign  of  withdrawal  treatment  failure. 
If  this  occurs,  the  patient  should  be  encouraged  to  switch  to  a  methadone  main- 
tenance program  (if  he  is  eligible)  at  blockading  doses  of  about  100  milligrams 
per  day. 

D.  Exceptions 

If  a  patient  fails  at  outpatient  withdrawal  even  if  he  has  used  heroin  for 
less  than  1  year  or  if  he  is  less  than  18  years,  he  may  be  considered  for 
methadone  maintenance  if  he  volunteers  for  this  treatment.  However,  under 
these  circumstances,  the  director  of  the  NTA  must  be  notified  of  each  such  ex- 
ceptional patient. 

III.  Physical  Examinations 

Every  patient  receiving  methadone  must  have  a  physical  examination  per- 
formed by  a  physician  within  30  days  after  the  first  dose  of  methadone.  Physical 
exams  should  occur  as  soon  as  possible. 

IV.  Records 

A.  Medical  records 

Patients  who  take  methadone  must  have  physical  examinations  and  medical 
histories  performed  by  a  licensed  physician  or  medical  student  working  under 
the  supervision  of  a  physician.  The  results  of  these  examinations  must  be  in- 
cluded in  the  patient's  clinical  record  and  the  date  of  physical  examination  must 
also  be  noted  on  NTA  Form  10  (see  attachment  7. ) 

Form  10  "Record  of  Patient  Prescription"  must  also  be  used  by  the  physician 
to  record  all  new  NTA  patients'  medical  treatment,  or  major  changes  in  treat- 
ment of  an  existing  NTA  patient. 

B.  Accountability  of  methadone 

Each  bottle  of  methadone  liquid  (1,000  cc. )  disbursed  to  the  centers  for  pa- 
tient treatment  will  contain  an  envelope  showing  the  same  registered  number  as 
that  appearing  on  the  label  affixed  to  the  bottle. 

Everytime  a  patient  has  received  a  dose  of  methadone,  a  copy  of  NTA  form  6, 
"Record  of  Patient  Activity,"  (see  attachment  5)  used  to  record  the  amount  of 
methadone  disbursed,  will  be  filed  in  the  envelope  containing  the  same  registered 


188 

number  as  that  on  the  bottle.  When  the  large  bottle  is  emptied,  the  envelope 
containing  the  NTA  forms  6,  showing  total  disbursements  (1,000  cc. )  will  be 
sealed  and  returned  to  Information  Central  via  messenger.  The  forms  in  the 
envelope  will  tell  the  pharmacist  the  date,  the  dosage  level,  and  names  of  the 
patients  who  were  served  out  of  that  particular  bottle.  All  doses  of  methadone 
dispensed  must  be  strictly  accounted  for  at  all  times. 

C  Discrepancies 

NTA  form  14,  "Director's  Discrepancy  Notice"  (see  attachment  8)  will  be 
used  to  notify  the  physician  of  any  discrepancies  in  recordkeeping  or  NTA  pro- 
cedures as  noted  by  the  computer. 

The  following  are  some  items  which  may  be  noted  : 

1.  Dosage  level  higher  than  that  prescribed  by  the  physician. 

2.  Irregular  dosage  level. 

3.  Consistently  dirty  urine. 

4.  No  physical  examinations  within  30  days  of  initial  intake. 

5.  Discrepancy  in  methadone  medication  disbursement. 

6.  Lack  of  proper  patient  evaluation. 

7.  Apparent  lack  of  patient  progress. 

8.  Exception  to  take-home  medicine  policy. 

D.  Confidentiality  of  records 

The  Narcotics  Treatment  Administration  respects  the  basic  right  of  patients 
to  have  all  information  and  treatment  records  maintained  with  strict  confiden- 
tiality. NTA  regards  this  effort  as  vital  to  the  establishment  of  an  effective  treat- 
ment relationship  with  its  patients. 

For  this  reason,  only  Information  Central  is  authorized  to  release  information 
on  patients  to  vertified  requestors.  With  the  exception  of  criminal  justice  and 
civil  commitment  patients  and  patient-employees,  no  information  on  any  patient 
will  be  released  unless : 

1.  The  patient  has  signed  and  Information  Central  has  received  NTA 
form  28  "Patient  Consent  for  Release  of  Treatment  Information"  (see 
attachment  9)   specifically  authorizing  the  requestor  access  to  information: 

2.  Information  Central  has  received  the  request  for  information  in  writ- 
ing ;  and 

3.  Information  Central  has  verified  the  current  status  of  the  patient  vis- 
a-vis the  requestor. 

Criminal  justice  system  patients  are  those  who  have  been  formally  referred 
to  NTA  by  the  police,  courts.  Department  of  Corrections,  or  parole  board  as  a 
condition  of  release  to  the  community.  Requests  for  information  on  these  patients 
by  the  agency  must  be  honored  immediately  by  the  program  chief  or  his  designee. 
The  request  and  the  response  should  preferably  be  made  in  writing  and  the 
current  status  of  the  patient  vis-a-vis  the  requestor  verified  before  the  informa- 
tion is  released.  Information  should  be  released  in  the  form  of  treatment  sum- 
maries whenever  possible. 

Civil  commitment  patients  are  those  brought  to  an  NTA  facility  under  signed 
pickup  orders  by  the  Narcotics  Squad  of  the  Metropolitan  Police  Department. 
The  results  of  their  diagnostic  evaluation  and  determination  of  their  treatment 
status  is  automatically  forwarded  to  the  referring  agency — the  Metropolitan 
Police  Department. 

Patient-employees  are  staff  members  of  NTA  who  also  remain  in  a  treatment 
status  with  NTA.  They  will  be  required,  as  a  condition  of  employment,  to  remain 
free  of  illegal  drugs,  and  must  agree  to  release  information  on  their  urine 
surveillance  reports  and  pertinent  medical  summaries  to  their  immediate  super- 
visors, program  unit  chiefs,  and  the  coordinator  of  counselors.  Such  information 
will  not  be  shared  with  other  staff  members  but  can  be  used  as  a  basis  for 
disciplinary  action  or  suspension  of  employment  if  confrontation  does  not  result 
in  termination  of  illegal  drug  use. 

Minors  under  21  years  of  age  should  be  encouraged  to  authorize  a  parent  or 
guardian  to  receive  at  least  a  summary  statement  of  their  treatment  status. 

Emerfjcneirs  arising  when  an  NTA  patient  is  confined  because  of  arrest,  ill- 
nes.s,  or  accident  will  receive  immediate  attention.  Every  effort  will  be  made  to 
assure  the  patient  immediate  medical  assistance  to  maintain  his  medication 
level  for  the  duration  of  the  emergency  upon  request  from  the  medical  authori- 
ties attending  the  patient. 


189 

Attachment  One 

Informed  Consent  to  Take  Methadone  Treatment  in  the  Narcotics 

Treatment  Administration 

I, ,  understand  that  methadone  treatment  for  chronic  heroin 

addiction  and  its  consequences  is  a  new  use  of  an  established  drug.  I  further 
understand  that  methadone  is  a  powerful  and  addictive  narcotic  drug  and  that 
if  I  stop  taking  it  I  will  experience  serious  withdrawal  symptoms.  Although 
methadone  treatment  has  been  used  successfully  by  thousands  of  people  through- 
out the  country,  I  also  understand  that  the  long-term  effect  of  this  drug  on 
humans  is  not  entirely  known  at  this  time. 

I  willingly  give  my  informed  consent  to  take  methadone  under  the  careful 
supervision  and  control  of  the  NTA  staff  or  NTA  cooperating  agency  staff.  I 
have  tried  to  stop  using  illegal  drugs  and  I  now  think  that  methadone  is  neces- 
sary for  me  to  avoid  further  use  of  illegal  drugs. 

I  have  not  been  forced  or  pressured  into  this  dec' '■ion.  I  understand  that  I 
can  stop  methadone  treatment  at  my  own  discretion  and  that  the  staff  may 
terminate  me  at  their  discretion.  If  I  do  stop  methadone  treatment  for  any 
reason,  I  understand  that  for  my  own  safety  I  should  withdraw  from  methadone 
by  using  gradually  reduced  doses  of  the  medication  under  the  control  of  the 
medical  staff. 


Signature  and  date 


Printed  or  typed  name 


NTA  patient  number 


Program  name 


"Witness 

Signature  and  date 
NTA  FORM  19(10-70). 


ATTACHMENT  TWO     , 


1.0.  NO. 

PATIEfJM!)  NAM                                            ■     "    - 

^OCRGE NC Y .  ADDRESS  iMoTJiERyRtLAIiyEO " .. 

CENTER  ASSIGNED 

TRANSFERRED   TO  (Cente,^  Date) 

SOCIAL  SECURITY  NO. 

BIRTHOATE 

DATE  NO.  ASSIGNED 

PHONt   NO. 

WgiKING  NOW? 
□  YES      □  N8 

EXMRATION  DATE 

EMPLOYER'S  NAf€  4  ADDRESS (If  WORKING)  ' 

DATE  PICTURE  SCHEOUlfO 

DATE  PICTURE  TAKEN 

NTA  FORM  7  (8.70)      RECORD  OF  PATIEKT   1.0.   NUFfiER  ASSIGNED 


190 

Attachment  Three 
To  all  medical  staff 

On  schedules  10,  11,  and  12,  the  value  of  X  (the  initial  dose)  must  be  speci- 
fied on  the  initial  prescription  along  with  which  schedule  is  being  used. 

On  schedule  12,  it  must  be  specified  at  what  does  the  schedule  stops. 


Day 


1  . 

2  . 

3  . 
4 

5  . 

6  . 

7  . 

8  . 

9  . 
10 


Detoxification  schedule  1 
Milligrams    Day  : 


20 

11 

20 

12 

20 

13 

15 

14 

15 

15 

15 

16 

15 

17 

15 

18 

10 

19 

10 

20 

1  Detoxification  completed. 


Day 


1  . 

2  . 

3  - 

4  . 

5  - 

6  - 

7  . 

8  - 

9  . 
10 
11 
12 
13 
14 
15 
16 
17 
18 
19 
20 
21 
22 
23 
24 
25 
26 


Detoxification  schedule  2 
Milligrama    Day  : 


50 

27 

50 

28 

50 

29 

50 

30 

50 

31 

45 

32 

45 

33 

45 

34 

45 

35 

45 

36 

40 

37 

40 

38 

40 

39 

40 

40 

40 

41 

35 

42 

35 

43 

35 

44 

35 

45 

30 

46 

30 

47 

30 

48 

30 

49 

30 

50 

30 

51 

25 

Milligrams 

10 

10 

10 


0 
0 


Milligrams 

25 

25 

25 

25 

20 

20 

20 

20 

20 

15 

15 

15 

15 

15 

10 

10 

10 

10 

10 

5 

5 

5 

5 

5 

(') 


1  Detoxification  completed. 


Detoxification  Schedule  S 

Day  :                                                   Milligrams  Day : 

1 20  43 

15 15  50 

29 10 


Milligrams 

5 
0 


Detoxification  Schedule  4 


Day: 
1  _ 
15 
29 
43 


Milligrams 
30 
25 
20 
15 


Day: 
57 
71 

85, 


Milligrams 

10 
5 
0 


Day; 


191 


Maintenance  Schedule  10 
Day: 


1 X  mgs.  10. 

2 X  mgs.  11. 

3 X+5  mgs.  12. 

4 X+5  mgs.  13. 

5 X+10  "  14. 

6 X+10  "  15. 

7 X+15  "  16. 

8 X+15  "  17. 

9 X+20  "  18_ 


X+20  mgs. 
X+25  " 
X+25  " 
X+30  " 
X+30  " 
X+35  " 
X+35  " 
X+40  " 
X+40  " 


To  100  mgs.  total  or  until  otherwise  stopped  by  adding  5  mgs.  to  dose  every 
other  day. 


Maintenance  Schedule  11 


Day: 
1. 
2. 
3- 
4. 
5- 
6. 


Day: 


-.X  mgs. 
..X  mgs. 
-X  mgs. 

-.X+5  mgs. 
-  X-i-5  mgs. 
-.X+5  mgs. 


7- 
8__ 
9_- 
10- 
11_ 
12. 


.  X+10  mgs. 
-X+IO  mgs. 
-X+IO  mgs. 
-X+15  mgs. 
-.X+15  mgs. 
.X+15  mgs. 


To  100  mgs.  total  by  increasing  by  5  mgs.  every  third  day  or  until  stopped  by 
prescription. 

Maintenance  Schedule  12 


Day: 

1 X  mgs. 

8 X+5  mgs. 

15 X+10  mgs. 


Day: 

22 X+15  mgs. 

29 X+20  mgs. 


Attachment  Four 

Statement  of  Responsibility  for  Take  Home  Medication 

I, ,  understand  that  methadone  is  a  powerful  drug  which 

can  seriously  harm  or  even  kill  a  person  who  is  not  on  methadone  maintenance. 
For  this  reason,  I  agree  to  put  my  methadone  bottle  in  a  locked  container,  out 
of  children's  reach.  I  also  agree  to  tell  my  family  how  dangerous  methadone  can 
be  and  take  all  necessary  precautions  to  prevent  its  accidental  use. 

In  addition,  I  understand  that  I  must  not  lose,  break  or  fail  to  return  my 
methadone  bottle  to  the  clinic  or  revert  to  drug  u.se.  If  I  do,  I  will  not  be  able 
to  take  methadone  home  but  will  have  to  I'eport  into  the  clinic  daily  for  at  least 
30  days. 


Patient  signature  and  date 


Printed  or  typed  name 


ID  number 


Program  name 


NTAForm  22  (11-70). 


Clinic  administrator,  piiysician 
or  nurse  signature  and  date 


192 

ATTACHMENT-  FIVE, 


•■    I   HI 
E    -  < 

ofo 


Oo 


PATIENT'S  IDENTIFICATION 


J:     I 


NARCOTICS  TREATMENT  ADMINISTRATION 


CENTER   ADDRESS 


PATIENT'S  SIGNATURE 


ADMIN.  BY  (Sign Below) 


METHADONE 


COUNSELING 


DOSAGE  LEVEL 


NARCOTICS  TREATMENT 
ADMINISTRATION 


STATUS 
□  hold      □detox.     □  MAINT.     □abstinence       □  SURV.  ONLY 


TESTS  REQUESTED 


COCAINE 


AMPHETAMINE 


BARBiTURATES 


TEST    RESULTS 


^^^^y^,Lj.U^ 


''<M/////MyMmy/yM:/,ymA''/Z 


OTHERS  (Specify) 


I       I  ALL  TESTS  NEC. 


I       I  REPEAT 


CHECK    APPROPRIATE   BOX 

E  SURVEILLANCE 


-j         I  URINE 


D' 


lETHADONE 


n 


COUNSELING 


z 

UJ 

< 


Z 

UJ 

U 


ATTACHMENT  SIX 


^  5 

UJ  D 

0  J 

1  o 
3  U 

0  u. 

•"  o 

UJ  L> 

a  I- 

zy 

15 

1  o 

u.  UJ 
O  I 

°^ 


<  ° 


PATIENT'S  IDENTIFICATION 

1.  PATIENT  TRANSFERRED 

I 

1 

FROM(Pf*>:irnt   Cfnlot) 

TO(New  Ccntci) 

2.  PATIENT'S  CLASSIFICATION  (Check  approptiale  blocks)                                         j 

Participating  }n  Pvogram                                                                                                     1              ;' 

Voluntarily  withdrew  from  program  a/rer  completrng  treatment 

i 
i 

CENTER  ADDRESS 

DATE 

1 

involuntarily  withdrew  from  program-  incarcerated 

o 

Involuntarily  withdrew  from  program-/josp/fa//>edor  other  medical  reason 

1 

t 

ST 
5 
cr 

Disniisied  from  program -alcoholism  oi  drinking  problem 

COUNSELOR'S 
SIGNATURE 

Dismissed  from  program— bad  conduct  or  disciplinary  problem 

1 

0 

L. 

Deceased 

1 

J      ADMINISTRATOR'S  SIGNATURE 

Other  (specify)                                                                                                                                     i 

t/J 


(D  O 
•fi  ^  ^ 

3  4-  uj 


<  E 

SI:: 


193 

ATTACHMENT  SEVEN 


PATIENT'S  IDENTIFICATION 

DOSAGE  LEVEL 

NARCOTICS  TREATMENT 
ADMINISTRATION 

PATIENT'S  PROGRAM   SPECIFICATIONS 

1       I     DETOXIFICATION  SCHEDULE 

1                                    '                                                                                                         ' 

CENTER  ADDRESS      ,, 

DATE     , , 

n  MAINTENANCE  SCHEDULE 

R. 

o 

n~]HOLD                                                                                       '                                       j 

1 

o 

5 
cr 
0  , 

DATE  OF  PHYSICAL 

r]  OTHER  MEDICATION 

"■     DOCTOR'S  SIGNATURE 

Z 

QfHANGEOF  MEDICATIONS                                                                          1 

o 


ATTACH>ffi:NT  EIGHT 


DIRECTOR'S  DISCREPANCY  NOTICE 


PATIENT'S   NArt 


DATt 


TO:    The  Center  Administrator 

FROM:   Director,  Narcotics 

Treatment  Administration 


CE.^ER 


1.0.  NO. 


PLEASE  ADVISE  WITHIN  24  HOURS,  THE  REASON(S) 
FOR  THE  DISCREPANCIES  LHLCXED  BELOW. 


1.   MEDICATION 


PERIOD  COVERED 


□  record  not  R£CEIVEO(nt»  form  6)  r]"0  RECORD  CF  PATIENT'S   PHYSICAL  EXAM.        QoTHER  (explain) 

(lITA    FORM   10) 

QrECORD  REC'D  LATE(nt«  form  6)  QoOES  NOT  t€CT  ftDICAL  GUIDELINES 

n  NO  RECORD  CF  OR'S   PRESCRIPTION  Q  I  (CONSISTENT  WITH  OR'S  PRESCRIPTION 

" — '        (nTA    form   10)  INTA    FORM   10) 


PERIOD  COVERED 


URINE   ANALYSIS 


PI  HOST  RECENT  RECORD  NOT  REC'D  (Submit  nta  form  6)        jZI  QUANTITY  NOT  SIFFIC  lENTdjNs) 

Q RECORD  RECEIVED  LATEInta  form  6)  LH CONSISTENTLY  DIRTY (Th8  or  i«re  Tii*s) 


3.   CHANGE  OF  STATUS 


PERIOD  COVERED 


n 


NO  ACTIONS    INDICATED    IN  PAST  TW0(2)  WEEKS 
(rJTA  FORM  9) 


QnO  /CTIONS    INDICATED    IN  PAST  FOlf)  WEEKSd.)        (nta  form  9) 


PERIOD  COVERED 


COUNSELING 


n  NO  CONTACT    INDICATED    IN  PAST  WEEK(mt«  form  6)  0  NO  CONTACT    INDICATED    IN  THE  PAST 

(nta  form  6) 

□counselor's  REPORT  OVERDUE  (Counselor's  NA^c , ) 


{ 


I     I  TWO  WEEKS 
I     I  MONTH 


5.   SERVICE  AT  OTHER  CENTER 


NAf€  CF   OTHER  CENTER 


DATE 


PERIOD  COVERED 


Q  NO  REFERRAL   INDICATED  (nta  form  9) 


^ETHADONE   DISBURSEMENT 


TomniuFBEr 


PERIOD  COVERED 


n 


TOTAL  A:iOUrn  REPORTED  DOES   NOT   AGREE  WITH  Tt£ 
AMOUHT  DISBURSED    IN  TfC  BOTTLE 


AMOUNT   OF  DISCREPANCY  (-HJR  .) 


SIGNATJiE  OF  THE  DIRECTOR 


DATE 


TO:   DIRECTOR,  NARCOTICS  TREATMENT  ADMINISTRATION 


CENTER    AOnl'IISTRATOR'S    REPLY(USE   REVERSE   SIDE    IF    NECESSARY) 


SICNATlFE   OF  THE  CENTER   AOMI')ISTRAT0R 


DATE 


194 

ATTACHMENT  NINE 


GOVERNMENT  OF  THE  DISTRICT  OF  COLUMBIA 
Narcotics  Treatment  Administration 


PATIENT  CONSENT  FORM  FOR  RELEASE 
OF  TREATMENT  INFORMATION 


I  hereby  authorize  the  following  person/agency: 


Name 


Address 


Telephone 

I  vmderstancT'tEair'ohlyTnformation  Central  is  authorized 
to  release  this  information.   This  consent  form  is  void  after 


PATIENT  SIGNATURE, 
DATE      


WITNESS 


195 

A.O.  202.1 
Addendum 
April  7,  1971 
OD 
Administration  Order 

1.  Purpose 

The  purpose  of  this  administration  order  is  to  provide  additional  clarification 
for  the  medical  and  program  guidelines  as  originally  issued  for  the  Narcotics 
Treatment  Administration  programs  and  cooperating  agencies. 

2.  Procedures 

Anyone  missing  3  days  medication  at  any  center  is  to  have  his  medication  dis- 
continued until  he  sees  the  doctor  at  the  center,  at  which  time  he  will  need  a  new 
prescription  signed  by  the  physician.  If  a  physician  is  not  immediately  available, 
the  patient  may  be  given  an  emergency  dose  not  to  exceed  25  mgs.  to  hold  him 
until  he  can  see  the  physician. 

No  new  patient  can  be  given  a  dose  in  excess  of  50  mgs.  on  the  first  day  of  his 
program,  whether  it  is  maintenance  or  detoxification,  unless  it  can  be  verified 
that  he  is  being  transferred  from  a  maintenance  program  and  is  currently  on  a 
higher  dose. 

[Exhibit  No.  11(e)] 

A  Study   of  Narcotics  Addicted  Offenders  at  the  District  of  Columbia  Jail 

(By  Nicholas  J.  Kozel,  Barry  S.  Brown,  and  Robert  L.  DuPont,  Narcotics  Treat- 
ment Administration,  Washington,  D.C.) 

(An  acknowledgement  of  appreciation  is  made  to  Charles  Rodgers,  Superintendent  of  the 
District  of  Columbia  Jail,  for  his  cooperation  and  assistance  in  this  study  and  to  the 
research  assistants  for  their  unremitting  effort  to  collect  data  under  extraordinary 
conditions. ) 

A  study  was  conducted  at  the  District  of  Columbia  Jail  between  August  11  and 
September  22,  1969,  in  an  effort  to  determine  the  parameters  of  heroin  use  in  the 
District  of  Columbia.  Findings  of  the  study  are  based  on  responses  to  interview 
schedules  personally  administered  by  a  team  of  research  assistants  and  the  re- 
sults of  urinalysis  conducted  separately  by  the  research  assistants. 

METHOD 

Interview  schedules  were  completed  on  an  accidental  sample  of  225  of  the  resi- 
dents present  at  the  District  of  Columbia  Jail  during  the  time  the  study  was  con- 
ducted. In  addition,  urine  specimens  were  collected  from  129  of  those  interviewed. 
Urine  specimens  were  collected  from  as  many  new  offenders  as  possible  at  the 
time  of  their  admission.  The  research  team  subsequently  attempted  to  intersnew 
as  many  of  these  new  admissions  as  they  could  reach — usually  within  the  first 
few  days  of  incarceration. 

To  determine  whether  the  sample  interviewed  was  representative  of  the  larger 
offender  population  from  which  it  had  been  drawn,  comparisons  were  made  on  se- 
lected personal  and  .social  characteristics.  Comparisons  made  on  age,  race,  number 
of  prior  commitments,  and  offense  for  which  presently  incarcerated  indicated  that, 
in  terms  of  the.se  characteristics,  the  sample  was  representative  of  the  District  of 
Columbia  Jail  population. 

RESULTS 

Drug  use 

Among  the  225  offenders  interviewed,  45  percent  were  identified  as  addicted  to 
heroin.  Forty-three  percent  admitted  using  heroin  and  having  been  addicted  to  it. 
An  additional  2  percent  of  the  total  sample — 3  percent  of  the  sample  of  urinal- 
yses— reported  never  haviD<r  used  heroin  or  refused  to  answer  the  question  con- 
cerning lieroin  use,  but  had  positive  urinalysis  results  for  morphine  and/or 
quinine — the  components  of  heroin  (table  1).'  Thus,  45  percent  of  all  per.sons  ad- 
mitted to  the  District  of  Columbia  Jail  can  be  described  as  addicted  to  heroin. 

Among  nonaddicts,  22  percent  stated  they  had  u.sed  drugs  at  some  time  in  the 
pa.st  (table  2).  Of  these,  most  started  out  on  marihuana.  At  the  same  time,  almost 


^  This  veracity  among  narcotics  addicts  supports  Ball's  findings  in  his  study  of  addict 
interview  responses.  Ball,  John  C.  "The  Reliability  and  Validity  of  Interview  Data  Obtained 
from  59  Narcotic  Drug  Addicts."  The  American  Journal  of  Sociology,  1967,  72(6),  650-654. 


196 

half  of  the  addicts  stated  that  marihuana  was  the  first  drug  they  had  ever  used. 
About  a  quarter  of  the  addicts,  however,  started  out  directly  on  heroin  (table  2a). 

Cocaine. — The  great  majority  of  self-reported  addicts — 85  percent — have  used 
cocaine,  usually  trying  it  for  the  first  time  after  they  had  turned  20  years  of  age. 
More  than  half  of  those  who  have  used  cocaine  in  the  past  admit  to  still  using  it. 
At  the  same  time,  29  jiercent  of  the  nonaddicts  who  admitted  using  drugs  liave 
tried  cocaine  (tables  3,  3a,  and  3b). 

Marihuana. — Marihuana  has  been  used  by  far  more  nonaddict  drug  users — 
68  percent. — than  any  other  drug.  Similarly,  75  percent  of  the  self-reported  addicts 
have  used  marihuana.  Among  addicts,  around  a  third  had  used  marihuana  for 
the  first  time  before  age  17.  but  when  both  groups  are  combined,  50  percent  report 
having  used  marihuana  for  the  first  time  when  they  were  older  than  IS  years. 
About  half  of  the  nonaddicts  and  a  third  of  the  addicts  who  had  tried  marihuana 
in  the  past  are  still  using  it  ( tables  4,  4a,  and  4b ) . 

Barbiturates. — Eighteen  percent  of  self-reported  addicts  admit  having  used 
barbiturates.  Like  marihuana,  barbiturates  were,  for  the  most  part,  "first  tried 
after  the  user  had  reached  18  years  of  age.  Five  of  the  17  addicts  who  have  used 
barbiturates  state  they  are  using  them  at  present   (tables  5,  5a,  and  5b). 

Methadone. — Street  methadone  has  been  used  by  16  percent  of  self-reported 
addicts.  None  of  the  nonaddict  drug  users  report  ever  having  used  street 
methadone. 

Amphetamines. — Among  self-reported  addicts  and  nonaddict  drug  users,  18 
percent  mention  having  used  amphetamines.  Use  of  amphetamines  begins  at 
about  18  and  half  of  those  who  have  used  them  in  the  past  continue  to  use 
them  at  present  (tables  7.  7a,  and  71)). 

Heroin. — Though  not  addicted,  four  of  the  28  nonaddict  drug  users  have 
used  heroin.  By  definition,  all  of  the  addicts  have  used  heroin.  In  terms  of  age, 
half  of  the  addicts  had  used  heroin  for  the  first  time  before  they  were  20  years 
old.  Indeed,  26  percent  had  used  heroin  by  17  ( tables  8  and  8a ) . 

Heroin  addiction 

Withdrawal. — The  overwhelming  majority  of  self-reported  heroin  addicts — 
88  percent — stated  that  they  had  experienced  withdrawal  symptoms  (table  9). 
At  the  same  time,  only  38  percent  recall  ever  receiving  treatment  for  their 
addiction  problem  (table  9a ) . 

Off  drugs  during  past  5  years. — Eighty -five  percent  of  addicts  report  having 
been  off  the  drugs  for  some  period  of  time  during  the  past  5  years  (table  10). 
The  number  of  times  drugs  have  been  voluntarily  or  involuntarily  given  up 
ranges  from  one  to  more  than  10,  with  over  half  of  the  addicts  claiming  to  have 
been  off  drugs  three  times  or  less  during  the  past  5  years  ( table  10a ) . 

Support  of  habit. — The  average  reported  cost  of  a  heroin  habit  is  .$44  a  day. 
Not  surprisingly,  the  majority  of  heroin  addicts  have  resorted  to  crime  as  a 
means  of  supporting  their  habit  (table  11).  Crime,  hustling,  and  pushing  drugs, 
alone  or  in  combination  with  legitimate  employment  are  the  usual  ways  in  which 
habits  are  supiwrted  (table  11a ) . 

Stop  own  drug  use. — Eighty-eight  i>ercent  of  addicts  believe  that  they  can 
stop  using  drugs  (table  12).  A  variety  of  ways  of  stopping  drug  use  were  men- 
tioned including  changing  environments,  methadone  or  other  treatment,  work, 
and  jail.  However,  26  percent  of  those  who  believe  they  can  stop  feel  they  could 
just  stop  without  outside  assistance,  while  an  additional  11  percent  either  could 
not  answer  or  did  not  know  how  to  stop  their  own  drug  use  (table  12a). 

Drug  use  among  family. — There  is  reportedly  little  drug  use  among  members 
of  the  addicts'  families — ranging  from  5  percent  among  si>ouses  to  10  percent 
among  siblings.  At  the  same  time,  there  is  a  relatively  high  incidence  of  don't 
know/no  answer  responses  to  questions  about  family  drug  use  (tables  18.  13a, 
and  13b).  This  suggests  that,  while  inclined  to  l>e  candid  about  their  own  history 
of  drug  use,  addicts  may  be  less  than  willing  to  revenl  information  about  their 
family  which  they  feel  would,  in  some  way,  place  their  family  in  jeopardy. 

Drug  use  among  friends. — The  preponderance  of  addicts  report  that  at  least 
some  of  their  fHpnds  usp  drugs.  Indeed,  a  third  state  that  all  of  their  friends 
are  drug  u.sers,  while  2  T)ercent  deny  having  any  friends  who  u.se  drugs  (table  14). 

Age  of  drug  users. — Slightly  more  than  a  third  of  the  addicts  reiwrt  that  most 
heroin  iisers  today  are  between  16  and  25  years  of  age.  At  the  same  time,  an- 
other third  either  don't  know  or  didn't  respond  lo  the  nuestion  (table  15).  Drug 
use,  according  to  a  majority  of  the  addicts,  presently  begins  among  youtlis  between 
15  and  17  years  old  ( table  1 5a ) . 

Methadone  treatment. — Eighty-six  percent  of  self-reported  heroin  addicts  have 


197 

heard  of  methadone  treatment  as  a  way  of  overcoming  illegal  drug  use  (table  16). 
Of  these,  almost  three-quarters  believe  methadone  treatment  is  good  without 
qualification,  while  an  additional  7  percent  feel  that,  on  the  whole,  it  is  good, 
but  still  have  some  reservations  about  it  (table  16a) . 

Personal  and  social  characteristics 

Age  and  education. — About  a  third  of  addicts  and  nonaddicts  are  21  years 
old  or  younger  and  two-thirds  are  under  30  (table  17).  More  than  75  percent 
of  the  two  groups  have  had  some  high  school  education,  and  25  percenit  report 
graduating  from  high  school  (table  18). 

Parents. — Approximately  80  percent  of  addicts  and  nonaddicts  claim  to  have 
been  reared  by  their  biological  parents  (table  19).  At  the  same  time,  a  greater 
number  of  addicts  as  compared  to  nonaddicts  report  that  both  of  their  parents 
are  stSll  living  (table  20). 

Among  those  whose  parent (s)  are  deceased,  about  50  percent  of  the  addicts 
were  less  than  16  when  one  or  both  parents  died,  while  about  half  of  the  non- 
addicts  were  between  16  and  21  when  death  of  parent (s)  occurred  (tables  20a 
and  20b). 

Siblings. — Compared  to  addicts,  nonaddicts  tend  to  have  more  brothers  and 
sisters.  Thirty  percent  of  nonaddicts  have  four  or  more  brothers  and  20  percent 
have  four  or  more  sisters  compared  to  15  and  11  percent  respectively  for 
addicts  (tables  21  and  21a). 

Religion. — Both  addicts  and  nonaddicts  are  more  likely  to  be  members  of 
Protestant  seots  than  other  religious  groups.  At  the  same  time,  a  significantly 
greater  number  of  nonaddicts  compared  to  addicts  report  religious  aflBliation 
(table  22).  Furthermore,  while  there  was  noticeably  more  frequent  attendance 
at  religious  ser\iees  during  childhood  among  both  groups,  significantly  more 
nonaddiots  compared  to  addicts  claim  to  attend  services  at  present  (tables  22a 
and  22b). 

Martial  status. — The  majority  of  both  addicts  and  nonaddicts  are  single  (table 
23).  Among  those  who  are  married,  slightly  more  addicts  report  having  been 
married  for  2  years  or  less  (table  23a).  Both  groups  have  experienced  a  high 
incidence  of  separation  from  their  spouses — 60  percent  on  the  average  (table  23b). 

Employment  status. — Significantly  more  nonaddicts  than  addicts  were  employed 
at  time  of  arrest  (table  24).  The  majority  of  both  groups  were  employed  by  tht* 
time  they  reached  18  years  of  age  (table  24a)  and  the  usual  type  of  employment 
for  both  groups  is  unskilled  labor  (table  24b) .  More  than  half  of  both  groups  have 
been  employed  at  three  or  le.ss  places  during  the  past  5  years  (table  24c). 

Residence. — Neither  group  is  very  mobile.  Twenty-three  percent  of  the  non- 
addicts  and  33  percent  of  the  addicts  have  resided  at  the  same  home  for  the 
past  5  years.  Over  70  percent  of  the  two  groups  have  changed  their  residences 
less  than  three  times  during  the  past  5  years  (table  25).  Further,  about  half 
of  both  groups  resided  for  more  than  1  year  at  the  home  in  which  they  were 
living  at  the  time  of  their  arrest  ( table  25a ) . 

Income. — Almost  two-thirds  of  addicts  and  nonaddicts  supported  themselves 
financially  at  time  of  arrest.  Twenty  percent  were  dependent  on  their  parents 
(table  26).  About  half  of  both  groups  reported  that  the  weekly  income  of  the 
home  in  which  they  were  living  when  arrested  was  between  $51  and  $150  (table 
26a). 

City  of  Birth. — Significantly  more  addicits  were  born  and  spent  most  of  their 
childhood  in  large  cities  as  compared  to  nonaddicts  (tables  27  and  27a). 

Military  service. — Between  25  and  29  percent  of  the  two  groups  served  in  the 
military  (table  28).  Nonaddicts  had  slightly  more  years  of  service  (table  28a) 
and  70  percent  of  both  groups,  on  the  average,  reported  having  had  honorable 
discharges  (table  28b) . 

Criminal  offenses. — In  terms  of  pre.sent  offenses,  addicts  are  charged  with 
more  offenses  against  property  and  drug  violations — 37  and  15  percent  respec- 
tively as  comapred  with  30  and  6  percent  respectively  for  nonaddicts.  Non-addicts 
are  charged  are  larceny  and  theft,  while  nonaddicts  are  not  charged  with  any 
addicts  (21  percent).  However,  three  of  the  four  criminal  homicides  reported 
were  charged  against  addicts.  The  most  frequent  crimes  with  which  addicts 
are  charge  are  larceny  and  theft,  while  nonaddicts  are  not  charged  with  any 
single  offense  with  outstanding  frequency  ( table  29 ) . 


198 


CONCLUSIONS 

Certain  patterns  emerge  from  the  results  of  this  study.  One  of  the  most 
relevant  is  the  alarmingly  widespread  use  of  heroin  in  the  District  of  Columbia. 
Forty-five  percent  of  offenders  entering  the  District  of  Columbia  jail  are  heroin 
addicts.  Further,  there  is  reason  to  believe  that  hard  narcotics  are  l>pginning 
to  reach  a  younger  population.  Although  addicts  at  the  District  of  Columbia 
jail  started  using  drugs  in  their  late  teens  or  early  twenties,  drug  use  today  is 
starting  at  about  15  or  16  years  of  age.  The  profound  implications  of  this  problem 
for  society  are  apparent.  Addicts  must  turn  to  antisocial  behavior,  at  least  in 
part,  to  support  their  habit.  And  this  deviant  behavior  will  continue  to  increase 
as  a  function  of  addiction. 

Another  important  finding  is  the  lack  of  difference  between  addicts  and  non- 
addicts  in  the  criminal  justice  system.  It  appears  to  be  a  widely  held  belief  that 
addicts  belong  to  a  subculture  with  its  own  unique  membership  characteristics 
quite  distinct  from  the  nonaddict  criminal  subculture.  However,  the  similarity 
between  addicts  and  nonaddicts  in  terms  of  personal  and  social  characteristics 
and,  to  some  extent,  drug  use  (marihuana)  suggests  that  both  addict  and  non- 
addict  offenders  may.  in  fact,  belong  to  a  single  subculture  characterized  by  a 
variety  of  illegal  activties,  one  of  which  is  use  of  hard  narcotics. 

Although,  for  the  most  part,  addicts  and  nonaddicts  share  common  character- 
istics, there  are  a  few  areas  in  which  they  differ.  For  example,  nonaddicts  tend 
to  have  more  ties  to  the  community — come  from  larger  families  and  attend 
religious  services  with  much  greater  frequency — than  addicts.  These  indica- 
tions of  a  closer  relationship  with  the  community  may,  in  effect,  provide  addi- 
tional support  which  the  addict  finds  lacking. 

Addicts,  on  the  other  hand,  appear  to  be  more  urban,  having  been  born  and 
reared  in  large  cities  to  a  much  greater  extent  than  nonaddicts. 

The  results  a' so  point  out  a  difference  between  addicts  and  nonaddicts  in  terms 
of  the  offenses  with  which  they  are  charged.  This  provides  some  support  for  the 
idea  that  addicts  do  not  commit  crimes  against  people  with  the  same  frequency 
as  nonaddict  offenders. 

Contrary  to  the  stereotype  of  an  unstable,  highly  mobile  personality,  the  nar- 
cotics addict  appears  to  be  able  to  retain  employment.  A  surprisingly  high  per- 
centage of  addicts  were  employed  at  the  time  of  arrest  and.  indeed,  almost  half 
of  the  addicts  claim  to  have  supported  their  heroin  habit  in  part  through  work. 
Further,  adicts  showed  a  certain  stability  of  behavior — at  least  to  thf  extent  of 
not  differing  from  nonaddicts — in  maintaining  themselves  in  the  military. 

One  further  point  that  deserves  mention  is  the  apparent  interest  that  most 
addicts  have  in  stopping  their  own  drug  use.  The  great  majority  have  been  off 
drugs  at  some  time  during  the  past  several  years.  Most  addicts  al.so  l)elieve. 
realistically  or  not.  that  they  can  give  up  drugs  on  their  own.  In  addition,  even 
before  the  city  wide  narcotics  treatment  program  was  imniemented  in  which 
methadone  was  used  as  one  technique  of  treating  heroin  addiction,  most  addicts 
had  heard  about  methaone.  and  a  majority  of  these  believe  it  was  a  good  form 
of  treatment.  This  favorability  toward  methadone  may  provide  a  treatment 
climate  which  could  facilitate  rehabilitation. 

In  conclusion,  it  should  he  mentioned  that  intensive  research  in  narcotics  addic- 
tion and  treatment  has,  in  a  sense,  very  recently  begun.  Very  little  seems  to  be 
known  about  the  addict.  This  study  provides  some  basic  descriptions  of  a  specific 
addict  population.  Hopefully,  those  findings  will  suggest  new  areas  of  research 
aimed  at  combating  the  problem  of  heroin  addiction  in  the  community. 

TABLE  1.— POSITIVE  URINALYSES  FOR  MORPHINE  AND  OR  QUININE  AND  SELF-REPORTED  HEROIN  DEPENDENCE 


Urinalyses  and  self-reoorts: 

Interview  positive;  urine  oositive 

Interview/  positive;  urine  negative 

Interview  positive;  no  urine 

Interview  negative;  urine  positive 

Interview  negative;  urine  negative... 

Interview  negative;  no  urine 

Total 100  100 


Addict 

Non- 

addict 

Total 

Number 

Percent 

Number 

Percent 

Number 

Percent 

42 

42  . 

42 

19 

10 

10  . 

10 

4 

44 

44  . 

44 

20 

4 

4  . 

4 

2 

73 
52 

58 

42 

73 
52 

32 

23 

125 


100 


225 


100 


199 


TABLE  2.— SELF-REPORTED  USE  OF  DRUGS 


Addict 


Non-addict 


Total 


Number      Percent     Number      Percent     Number        Percent 


Ever  used  drugs: 

Yes 

No 

No  answer 

Total. 

First  drug  of  abuse: 

Marijuana 

Heroin 

Cocaine __- 

Other 

No  answer;  don't  know 

Total 


96 
2 

96 
2 
2  ... 

28 
97 

22 
78 

124 

99 

2 

55 
44 

2 

1 

100 

100 

45 
23 
13 
3 
16 

125 

17 

4 
2 

1 
4 

100 

61 
14 

7 

4 

14 

225 

60 
26 
14 
4 
20 

100 

43 

49 

22 

21 

12 

U 

3 

16 

3 

16 

96 


100 


28 


100 


124 


100 


TABLE  3.— PROFILE  OF  COCAINE  USE 


Addict 


Nonaddict 


Total 


Number      Percent     Number      Percent     Number        Percent 


Ever  used  cocaine: 

Yes 

No 

Total 

(a)  Age  at  1st  use  of  cocaine: 

14  years 

15years 

16  years _ 

17  years _ 

18  years..- 

19  years... 

20  years 

21  years  or  older 

No  answer;  don't  know 

Total 

(b)  Presently  using  cocaine: 

Yes 

No... 

No  answer 

Total 


82 

85 

15 

8 

20 

29 

71 

90 
34 

73 

14 

27 

96 

100 

28 

100 

124 

100 

1 

2 
4 
7 
6 
7 
12 
35 
8 


82 


1  _ 

2  

5  

9  2 

7 

9  

15  1 

42  3 

10  2 

8 

4 
4 

100  8 


1 
2 
4 
9 
6 
7 

13 
38 
10 


I 
2 

5 
10 
7 
8 
14 
42 
11 


82 

100 

8 --- 

90 

100 

46 

56 
23 
21  .... 

4 

4  _ 

50 
23 
17 

56 

19 

25 

17 

19 

90 


100 


TABLE  4.— PROFILE  OF  MARIHUANA  USE 


Addict 


Nonaddict 


Total 


Number      Percent     Number      Percent     Number        Ferceil 


Ever  used  marihuana: 

Yes -.- 72 

No 23 

No  answer.. 1 

Total ___.  96 

(a)  Age  at  1st  use  of  marihuana: 

13  years  Of  younger... 2 

14  years 5 

15  years 8 

16  years... 8 

17  years 6 

18  years  or  older 34 

No  answer;  don't  know 9 

Total.... 

(b)  Presently  using  marihuana: 

Yes 

No 

No  answer... _ 

Total 72 


100 


75      19      68  91  73 

24       9      32  32  26 

1  1  1 

100      28     100  124 

2  2  2 

7 5  5 

11       I       5  9  10 

11       1       5  9  10 

9       2      11  8  9 

47      11      58  45  50 

13       4      21  13  14 


72 

100 

19 

100 

91 

100 

22 

31 
47 
22 

9 
7 
3 

47 
37 
16 

31 
41 
19 

34 

34 

45 

16 

21 

100 


19 


100 


91 


100 


200 


TABLE  5.— PROFILE  OF  BARBITUARATE  USE 


Addict 


Nonaddict 


Total 


Number      Percent     Number      Percent     Number        Percent 


Ever  used  barbituarates: 

Yes - 

No... 


Total. 


(a)  Age  at  first  use  of  barbituarates: 

14  years  or  younger 

ISyears... 

16  years.. 

17  years 

18  years  or  older 

No  answer;  don't  know 


Total. 


(b)  Presently  using  barbiturates: 

Yes 

No. __ 

No  answer.. 


Total. 


17 

18 

82 

1 
27 

4 
96 

18 

106 

15 

79 

85 

96 

100 

28 

100 

124 

100 

1 
1 
1 
1 

12 
1 


17 


5 

10 
2 


17 


1 
1 
1 
1 

12 
2 


18 


5 

10 

3 


18 


TABLE6.— PROFILE  OF  STREET  METHADONE  USE 


Addict 


Nonaddict 


Total 


Number      Percent     Number      Percent       umber        Percent 


Ever  used  street  methadone: 

Yes _ 

No - 


Total. 


(a)  Age  at  first  use  of  street  methadone: 

18  years _ 

19  years 

20  years 

21  years  or  older 

No  answer ;  don't  know 


Total. 


(b)  Presently  using  street  methadone: 

Yes... 

No 

No  answer 


Total. 


15 
81 

16  ... 
84 

......... 

""""ioo" 

15 
109 

12 
88 

96 

100 

28 

100 

124 

100 

15 


15 


15 


15 


TABLE  7.-PR0FILE  OF  AMPHETAMINE  USE 


Ever  used  amphetamines: 

Yes 

No 


Total. 


(a)  Age  at  1st  use  of  amphetamine: 

16  years 

17  years... 

ISyears 

19  years  or  older 

No  answer;  don't  know 


Total. 


(b)  Presently  using  amphetamine: 

Yes... 

No 

No  answer 


Total. 


Addict 


Nonaddict 


Total 


Number      Percent     Number      Percent     Number        Percent 


12 
84 

13 
87 

4 
24 

14 
86 

16 
108 

13 
87 

96 

100 

28 

100 

124 

100 

12 


5 
5 
2 

12 


1 
2 
9 
2 
2 


16 


8  . 
6  . 
2  . 


201 

TABLE  8.-PR0FILE  OF  HEROIN  USE 


Addict 


Nonaddict 


Total 


Number      Percent     Number      Percent     Number        Percent 


Ever  used  heroin: 

Yes - 

No..._ 

Total... 

(a)  Age  1st  use  of  heroin: 

14  years  or  younger 1  1 

ISyears 5  5 

16years 8  8 

17years 11  12 

ISyears 12  13 

19years 11  12 

20years 8  8 

21  years 6  6 

Over21  years 34  35 

Total. 96  100 


96 

100 

4 
24 

14 
86 

100 
24 

81 
19 

96 

100 

28 

100 

124 

100 

1 
1 
1 

i' 

4 


1 

1 

5 

5 

8 

8 

11 

11 

13 

13 

12 

12 

9 

9 

6 

6 

35 

36 

100 


100 


TABLE  9.-HER0IN  WITHDRAWAL 


Addicts 


Number 


Percent 


Ever  withdrew: 

Yes 

No 

No  answer;  don't  know 

Total.. 

(a)  Treatment  for  heroin  addiction: 
Yes.. 

No 

No  answer;  don't  know 

Total 


84 

88 

11 

11 

1 

1 

96 

100 

36 

38 

55 

57 

5 

5 

96 


100 


TABLE  lO.-OFF  DRUGS  DURING  PAST  5  YEARS 


Addicts 


Number 


Percent 


Off  drugs: 

Yes 

No 

No  answer;  don't  know 

Total 

(a)  Number  of  times  off  drugs  during  past  5  years: 

4to5 

6  to  10 

More  than  10... 

No  answer;  don't  know 

Total 


82 

85 

13 

14 

1 

1 

96 

100 

19 

23 

26 

32 

10 

12 

7 

9 

1 

1 

19 

23 

82 


100 


60-296  O — 71 — pt.  1- 


-14 


202 


TABLE  ll.-SUPPORT  OF  HEROIN  HABIT 


Addicts 

Number 

Percent 

Ever  commit  a  crime  to  support  habit: 
Yes 

57 
27 
12 

59 

No      

28 

No  answer 

13 

Total 

96 

100 

(a)  Usual  way  habit  was  supported: 

Hustling  (N  =96) 

55 
45 
42 
27 

57 

Work  (N  =96) 

47 

Crime  (N  =96) 

44 

Pushing  (N  =96)     .. 

28 

TABLE  12.- 

-BELIEVE  OWN  USE  OF  DRUGS  CAN  BE  STOPPED 

Addicts 

Number 

Percent 

Can  stop: 
Yes 

84 

1 
8 
3 

88 

No 

1 

8 

No  answer 

3 

Total 

96 

100 

(a)  Way  in  which  own  use  of  drugs  can 
Just  stop 

be  stopped: 

22 

16 

15 

12 

6 

4 

9 

26 

Change  environment 

Treatment;  therapy.. 

Methadone 

19 
18 
14 

Work 

7 

Jail                                 .  . 

5 

No  answer'  don't  know 

11 

Total 

84 

100 

Addicts 

Number 

Percent 

TABLE  13.-DRUG  USE  BY  SPOUSE 

Addicts 

Number 

Percent 

Drug  use: 

Yes                                  .    

2 

29 

9 

5 

No                     

73 

No  answer'  don't  know 

22 

Total 

40 

100 

(a)  Drug  use  among  siblings: 
Yes 

9 
62 

16 

1 

No                       .... 

71 

No  answer;  don't  know 

19 

Total 

87 

100 

(b)  Drug  use  among  other  members  of  the  family: 
Yes: 

Father                                                                             -  --  -.- 

3 
3 
3 

65 
26 

3 

Mother 

3 

Other 

3 

No                           ... 

65 

No  answer;  don't  know 

26 

Total 

100 

100 

203 

TABLE  14— DRUG  USE  AMONG  FRIENDS 


Addicts 


Number 


Percent 


Drug  use: 
Yes: 

All 

Most 

Some _ 

No 

No  answer;  don't  know. 


32 

32 

7 

7 

49 

49 

2 

2 

10 

10 

Total 

_ 100 

100 

TABLE  15.- 

-AGE  OF  MOST  HEROIN  USERS  TODAY  AS  REPORTED  BY  ADDICTS 

Addicts 

Number 

Percent 

Age: 

Less  than  10  years. 

11  to  15 _ 

16  to  20 _ 

21  to  25... ._ 

26  to  30.. 

31  to  35 

36  to  40 

More  than  40  years 

No  answer;  don't  know __ 

Total . 

(a)  Age  at  which  most  drug  use  presently  begins  as  reported  by  addicts 

12  years  or  younger.. 

13 _ 

14 

15. 

16 - 

17.. _ 

18  years  or  older.. 

No  answer;  don't  know 

Total _ 


3 

3 

6 

6 

20 

20 

16 

16 

8 

8 

5 

5 

3 

3 

7 

7 

32 

32 

100 


100 


2 

2 

5 

5 

11 

11 

17 

17 

28 

28 

12 

12 

13 

13 

12 

12 

100 


100 


TABLE  16.-FAMILIARITY  WITH  METHADONE  TREATMENT 


Addicts 


Number 


Percent 


Heard  of  methadone: 

Yes 

No 

No  answer 

Total 

(a)  Favorability  concerning  methadone  treatment 
Believe  methadone  treatment  is  good: 

Yes  (unqualified) 

Yes  (with  reservations)... 

No 

Don't  know.. 

No  answer 

Total.... _ 


86 
9 
5 


100 


100 


63 

73 

6 

7 

4 

5 

11 

13 

2 

2 

86 


100 


204 


TABLE  17.-AGE  OF  ADDICTS  AND  NONADDICTS 


Addict 


16  to  17 _ 

18tol9 _ 16  16 

20to21 14  14 

22to23 7  7 

24to25 _ 9  9 

26to27 9  9 

28to29. 9  9 

30to31... _. 9  9 

32to33 _ 4  4 

34to35.. 4  4 

36to37. _ .55 

38to39 _...  2  2 

40orolder 12  12 

Total.. 100  100 


Nonaddlct 

Total 

Number 

Percent 

Number 

Percent 

2 

1 

2 

1 

25 

20 

41 

18 

18 

14 

32 

14 

11 

9 

18 

8 

11 

9 

20 

9 

11 

9 

20 

9 

5 

4 

14 

6 

4 

3 

13 

6 

6 

5 

10 

4 

6 

5 

10 

4 

1 

1 

6 

3 

7 

6 

9 

4 

18 

14 

30 

14 

125 


100 


225 


100 


TABLE  18— HIGHEST  GRADE  COMPLETED 


Addict 


Nonaddict 


Total 


Number      Percent     Number      Percent     Number        Percent 


LessthanS 10  10  19  15  29  13 

8 __._ __  8  8  7  5  15  7 

9 - 13  13  22  18  35  16 

10 22  22  16  13  38  17 

11 21  21  25  20  46  20 

12 19  19  19  15  38  17 

Some  higher  education 6  6  12  10  18  8 

No  answer 115  4  6  2 

Total 100  100  125  100  225  100 


TABLE  19.— REARED  BY  NATURAL  PARENTS 


Addict 


Nonaddict 


Total 


Number 

Percent 

Nui 

Tiber 

Percent 

Number 

Percent 

79 

79 

102 

82 

181 

81 

20 

20 

17 

13 

37 

16 

1 

1 

6 

5 

7 

3 

Yes 

No 

No  answer. 

Total 


100 


100 


125 


100 


225 


100 


TABLE  20.-PARENTS  LIVING  OR  DECEASED 


Addict 


Nonaddict 


Total 


Number 

Percent 

Number 

Percent 

Number 

Percent 

49 

49 

45 

36 

94 

42 

25 

25 

37 

30 

62 

28 

11 

11 

16 

13 

27 

12 

11 

11 

18 

14 

29 

13 

4 

4 

9 

7 

13 

5 

Living  or  deceased: 

Both  parents  living 

Father  deceased _ 

Mother  deceased 

Both  parents  deceased 

No  answer,  don't  know 

Total 

(a)  Age  at  time  of  mother's  death 

5  years  or  younger. 

etc  15 

16to21.... 

Over  21 

No  answer;  don't  know.. 

Total 

(b)  Age  at  time  of  father's  death: 

5  years  or  younger 

6tol5_ 

16  to  21 ^... 

Over  21. 

No  answer;  don't  know.. 

Total ._ 


100 


36 


100 


100 


125 


55 


100 


100 


225 


91 


100 


4 

18 

3 

9 

7 

13 

7 

32 

8 

24 

15 

27 

2 

9 

8 

24 

10 

18 

7 

32 

13 

38 

20 

35 

2 

9 

2 

5 

4 

7 

22 

100 

34 

100 

56 

100 

7 

19 

4 

7 

11 

12 

12 

34 

20 

37 

32 

35 

6 

17 

7 

13 

13 

14 

7 

19 

21 

38 

28 

31 

4 

11 

3 

5 

7 

8 

100 


205 


TABLE  21.— NUMBER  OF  BROTHERS 


Addict 


Nonaddict 


Total 


Number      Percent     Number      Percent     Number        Percent 


Number: 

0 18  18 

1 21  21 

? - 24  24 

3. _._. 14  14 

4.. _.- 9  9 

5 3  3 

6 _.__ 

7 _ 2  2 

More  than  7 _._ 1  I 

No  answer;  don't  know 8  8 

Total ._ 100  100 

(a)  Number  of  sisters: 

0 16  16 

1--- - -- _.__  28  28 

2 22  22 

3 14  14 

4.. __ 5  5 

5 3  3 

6... 

7 1  i 

Morethan7 2  2 

No  answer;  don't  know 9  9 

Total 100  100 


21 

17 

39 

17 

22 

18 

43 

19 

25 

20 

49 

22 

11 

9 

25 

11 

17 

14 

26 

11 

8 

6 

11 

5 

6 

5 

6 

3 

3 

2 

5 

2 

5 

3 

6 

3 

7 

6 

15 

7 

125 


125 


TABLE  22.— RELIGIOUS  AFFILIATION 


100 


100 


Addict 


Nonaddict 


225 


225 


Total 


100 


12 

10 

28 

13 

31 

25 

59 

26 

35 

28 

57 

25 

13 

10 

27 

12 

9 

7 

14 

6 

7 

5 

10 

4 

1 

1 

1 

1 

7 

6 

8 

4 

1 

1 

3 

1 

9 

7 

18 

8 

100 


Number      Percent      Number      Percent      Number        Percent 


Affiliation: 

Protestant 43  43 

Catholic... 24  24 

Other 10  10 

None _ 23  23 

No  answer;  don't  knowi 

Total 100  100 

(a)  Childhood  attendance  at  religious  services: 

At  least  once  a  week 82  82 

Less  than  once  a  week 5  5 

Notatall 12  12 

No  answer;  don't  know _ 1  1 

Total 100  100 

(b)  Present  attendance  at  religious  services: 

At  least  once  a  week 26  26 

Less  than  once  a  week 10  10 

Notatall 63  63 

No  answer _ 1  l 

Total __.. 100  100 


63 

50 

106 

47 

32 

26 

56 

25 

17 

14 

27 

12 

11 

9 

34 

15 

2 

1 

2 

1 

125 


125 


125 


100 


100 


100 


225 


225 


225 


100 


99 

79 

181 

80 

11 

9 

16 

7 

9 

7 

21 

10 

6 

5 

7 

3 

100 


58 

46 

84 

37 

17 

14 

27 

12 

47 

38 

110 

49 

3 

2 

4 

2 

100 


206 


TABLE  23.— PRESENT  MARITAL  STATUS 


Addict 


Nonaddict 


Total 


Number      Percent     Number      Percent     Number        Percent 


Status: 

Married 

Single 

Separated  or  divorced 

No  answer... 

Total... 

(a)  Length  of  time  married: 

1  year  or  less... 

2  years 

3  to  4  years 

5  to  6  years 

7  toSyears 

9  to  10  years. 

More  than  10  years 

No  answer 

Total J 

(b)  Ever  separated  from  spouse 

Yes 

No. - 

No  answer 

Total 


21 

21 

24 

19 

45 

20 

57 

57 

68 

54 

125 

56 

15 

15 

32 

26 

47 

21 

7 

7 

1 

1 

8 

3 

100 


100 


125 


100 


225 


100 


6 

15 

5 

9 

11 

12 

6 

15 

4 

8 

10 

11 

4 

10 

9 

17 

13 

14 

5 

13 

9 

17 

14 

15 

7 

18 

3 

5 

10 

11 

3 

7 

4 

8 

7 

7 

8 

20 

12 

23 

20 

22 

1 

2 

7 

13 

8 

8 

40 

100 

53 

100 

93 

100 

25 

62 

33 

5 

31 

20 

2 

58 

38 

4 

56 

33 

4 

60 

13 

36 

2 

4 

40 


100 


53 


100 


93 


100 


TABLE  24.— EMPLOYMENT  STATUS 


Addict 


Nonaddict 


Total 


Number 

Percent 

Number 

Percent 

Number 

Percent 

Status: 

Employed 

41 

41 

76 

61 

117 

52 

Unemployed _. 

55 

55 

48 

38 

103 

46 

No  answer 

4 

4 

1 

1 

5 

2 

Total _ 

100 

100 

125 

100 

225 

100 

(a)  Age  at  which  first  started  working: 

15  years  or  younger 

15 

15 

13 

11 

28 

12 

16  years 

19 

19 

33 

26 

52 

23 

17  years 

20 

20 

22 

18 

42 

19 

18  yea  rs 

21 

21 

18 

14 

39 

17 

19  years 

4 

4 

8 

6 

12 

5 

20  years. .  _ 

6 

6 

8 

6 

14 

6 

21  years  or  older        

8 

8 

11 

9 

19 

9 

No  answer;  don't  know 

7 

7 

12 

10 

19 

9 

Total 

100 

100 

125 

100 

225 

100 

(b)  Usual  level  of  employment: 

Unskilled... 

45 

24 

22 

4 

45 

24 

22 

4 

65 
25 
22 

7 

52 

20 

18 

5 

110 
49 
44 
11 

49 

Semi-skilled.. 

22 

Skilled 

19 

Other 

5 

No  answer;  don't  know.  .      .  . 

5 

5 

6 

5 

11 

5 

Total :. 

100 

100 

125 

100 

225 

100 

(c)  Number  of  places  employed  during  past  5  years: 

0 .  

7 

7 

3 

2 

10 

4 

1 

17 

17 

16 

15 

33 

15 

2 

19 

19 

28 

23 

47 

21 

3 

23 

23 

24 

19 

47 

21 

4 

9 

9 

17 

14 

26 

11 

5 

6 

6 

9 

7 

15 

7 

More  than  5 

17 

17 

26 

20 

43 

19 

No  answer;  don't  know 

2 

2 

2 

2 

4 

2 

Total _ 

100 

100 

125 

100 

225 

100 

207 


TABLE  25.— NUMBER  OF  PLACES  RESIDED  DURING  PAST  5  YEARS 


Addict 


Nonaddict 


Total 


Number 

Percent 

Number 

Percent 

Number 

Percent 

33 

33 

29 

23 

62 

27 

46 

46 

60 

48 

106 

47 

8 

8 

12 

10 

20 

9 

2 

2 

5 

4 

7 

3 

1 

1 

3 

2 

4 

2 

5 

5 

1 

1 

6 

3 

5 

5 

15 

12 

20 

9 

Number: 

1 

2  to  3 

4  to  5 - 

6  to  7 -..- 

8  to  9 - 

10  or  more 

No  answer;  don't  know 

Total 

(a)  Lengtti  of  time  resided  at  home  in  which  living 
at  time  of  arrest: 

Less  than  1  month _ _. 

1  to  3  months 

3  to  6  months 

6  to  12  months 

1  to  3  years 

3  to  5  years 

More  than  5  years _ 

No  answer,  don't  know.. 

Total _ 


100 


100 


100 


100 


125 


100 


125 


100 


225 


225 


100 


17 

17 

20 

16 

37 

16 

10 

10 

13 

10 

23 

10 

8 

8 

7 

6 

15 

7 

11 

11 

17 

14 

28 

13 

17 

17 

24 

19 

41 

18 

8 

8 

7 

6 

15 

7 

27 

27 

28 

22 

55 

24 

2 

2 

9 

7 

11 

5 

100 


TABLE  26— MAIN  FINANCIAL  SUPPORT  OF  PEOPLE  IN  HOME  IN  WHICH  LIVING  AT  TIME  OF  ARREST 


Addict 


Nonaddict 


Total 


Number 

Percent 

Number 

Percent 

Number 

Percent 

Financial  support: 

Self 

Parent(s) 

Friends 

Relatives    . 

63 
21 
6 
4 
2 
1 
3 

63 
21 

6 

4 

2 

1  . 

3 

81 

25 

2 

5 

4 

8" 

65 

20 

2 

4 

3 

6 

144 
46 
8 
9 
6 
1 
11 

64 

20 

3 

4 

Spouse 

Other 

No  answer.. 

of  home  in  which  living 

3 

1 
5 

Total 

100 

100 

125 

100 

225 

100 

(a)  Total  weekly  income 
at  time  of  arrest: 

$50  or  less 

$51  to  $100 

3 

21 

27 

10 

5 

6 

4 

5 

19 

3 

21 

27 

10 

5 

6 

4 

5 

19 

7 
35 
31 
12 

7 
7 
1 
2 
23 

5 

28 

24 

10 

6 

6 

1 

2 

18 

10 
56 
58 
22 
12 
13 
5 
7 
42 

4 
25 

$101  to  $150 

26 

$151  to  $200      . 

10 

$201  to  $250 

5 

$251  to  $300 

6 

$301  to  $400 

2 

More  than  $400 

No  answer;  don't  know 

3 
19 

Total 

100 

100 

125 

100 

225 

100 

TABLE  27.-SIZE  OF  CITY  IN  WHICH  BORN 


Addict 


Nonaddict 


Total 


Number 

Percent 

Number 

Percent 

Number      Percent 

Size: 

Large  city  (over  500,000) 

72 
6 
7 
4 
1 
1 
9 

72 
6 
7 
4 
1 
1 
9 

62 
6 

19 

15 
5 
4 

14 

49 
5 

15 

12 
4 
3 

12 

134  

Medium  city  (100,000  to  500,000)  . 

12  

Small  city  (10,000  to  100,000) 

26 

Town  (1,000  to  10,000) 

19  

Village _._ _ 

Farm _ 

No  answer;  don't  know... 

6 

5 

23  

Total 

100 

100 

125 

100 

225  

(a)  Size  of  city  in  which  most  of  childhood  was  spent : 
Large  city  (over  500,000) _ 

74 
5 
5 
2 

1 

1 
12 

74 
5 
5 
2 

1 

1 

12 

67 
2 

18 

10 
2 
5 

21 

54 
2 

14 
8 

1 

4 

17 

141  

Medium  city  (100,000  to  500,000) 

7 

Small  city  (10,000  to  100,000)... 

23  

Town  (1,000  to  10,000) 

12 

Village 

Farm... _. 

3  

6  

No  answer;  don't  know 

33  

Total... 

100 

100 

125 

100 

225 

208 


TABLE  28.-MILITARY  SERVICE 


Service: 

Yes 

No 

No  answer 

Total 

(a)  Years  in  military  service: 

1  year 

2years 

3  years 

4  years 

More  thaa4  years 

No  answer _ 

Total 

(  b)  Type  of  military  discharge: 

Honorable 

Dishonorable 

Medical 

General.. ..- 

Other. 

No  answer;  don't  know 

Total _. 


Addict 

Nonaddict 

Total 

Number      Percent 

Number 

Percent 

Number 

Percent 

25 

25 

36 

29 

61 

27 

73 

73 

88 

70 

161 

72 

2 

2 

1 

1 

3 

1 

100 

100 

125 

100 

225 

100 

5 

20 

6 

17 

11 

18 

8 

32 

9 

25 

17 

28 

6 

24 

7 

19 

13 

21 

1 

4 

5 

U 

6 

10 

4 

16 

7 

19 

11 

18 

I 

4 

2 

6 

3 

5 

25 

100 

36 

100 

61 

100 

18 

72 

25 

70 

43 

70 

2 

8 

3 

8 

5 

8 

1 

4 

3 

8 

4 

6 

1 

4  . 

8 

4 

"l" 

3 

..... 
8 

1 
4 
4 

2 

2 

7 

1 

7 

25 


100 


36 


100 


61 


100 


TABLE  29.-OFFENSE  FOR  WHICH  PRESENTLY  CHARGED 


Addict 


Nonaddict 


Total 


Number      Percent     Number      Percent     Number 


Percent 


Offense: 

Larceny;  theft 21  21 

Drug  law  violation 15  15 

Robbery 10  10 

Possession  of  implements  of  crime 5  5 

Burglary 6  6 

Receiving  stolen  property _ 3  3 

Carry/possess  weapon 5  5 

Housebreaking 

Assault  (other  than  aggravated) 5  5 

Soliciting  (for  lewd  and  immoral  purposes) 4  4 

Criminal  homicide 3  3 

Forgery;  counterfeiting... 3  3 

Fraud;  embezzlement 2  2 

Autotheft 2  2 

Armed  robbery 1  1 

Bank  robbery 2  2 

Disorderly  conduct;  drunkenness 1  1 

Escape 2  2 

Destroying  private  properly 

Assault  (with  a  deadly  weapon) _. 

Offense  against  family. .  _ 

Traffic  violation. 1  1 

Obstructing  justice 

Parole/probation  violation 1  1 

Unlawful  entry.... 2  2 

Resisting  arrest 

Sex  offense 

Manslaughter 

Gambling 

Contempt 

Civil  action 

Ball  Act 

No  answer;  don't  know 6  6 

Total _ 100  100 


11 

8 

32 

8 

6 

23 

15 

12 

25 
5 

8 

6 

14 

3 

2 

6 

12 

9 

14 

1 

1 

1 

11 

9 

16 

1 

1 

5 

1 

1 

4 

3 

2 

6 

2 

2 

4 

6 

5 

8 

2 

2 

3 

1 

1 

3 

6 

5 

7 
2 

5 

4 

5 

4 

3 

4 

1 

1 

1 

4 

3 

5 

3 

2 

3 

1 

2 

1 

1 

1 

1 

1 

1 

2 

2 

2 

1 

I 

1 

1 

1 

1 

1 

1 

1 

1 

I 

1 

9 

7 

15 

14 
10 
11 
2 
6 
2 
6 


125 


100 


225 


100 


(Thereupon,  at  2:45  p.m.  the  hearing  adjourned,  to  reconvene  to- 
morrow, April  28, 1971,  in  room  2253,  at  9 :45  a.m.) 


NARCOTICS  RESEARCH,  REHABILITATION, 
AND  TREATMENT 


WEDNESDAY,  APRIL  28,    1971 

House  of  Representatives, 
Select  Committee  on  Crime, 

Washington^  D.C. 

The  committee  met,  pursuant  to  notice,  at  10 :00  a.m.,  in  room  2253, 
Ray  burn  House  Office  Building,  the  Honorable  Claude  Pepper  (chair- 
man) presiding. 

Present :  Representatives  Pepper,  Waldie,  Brasco,  Mann,  Murphy, 
Rangel,  Wiggins,  Steiger,  Winn,  Sandman,  and  Keating. 

Also  present:  Paul  Perito,  chief  counsel;  and  Michael  W.  Blom- 
mer,  associate  chief  counsel. 

Chairman  Pepper.  The  committee  will  come  to  order  please. 

The  Select  Committee  on  Crime  today  continues  its  hearings  into 
what  science  and  medicine  can  do  to  help  us  fight  heroin  addiction  in 
the  United  States. 

Yesterday,  we  heard  impressive  testimony  from  Dr.  Frances  Gear- 
ing of  New  York  and  Dr.  Robert  DuPont  of  the  District  of  Columbia 
on  the  effectiveness  of  methadone  programs. 

Today  we  are  continuing  our  examination  of  methadone  with  testi- 
mony from  Dr.  Jerome  Jaffe,  director  of  the  Illinois  Drug  Abuse 
Program. 

Dr.  Jaffe  was  originally  scheduled  to  testify  yesterday,  but  was 
kind  enough  to  stay  over  until  today  as  we  ran  behind  schedule  be- 
cause of  several  votes  on  the  floor. 

We  will  also  hear  testimony  today  from  Dr.  Harvey  Gollance,  as- 
sistant medical  director  of  Beth  Israel  Medical  Center  in  New  York. 

Both  Dr.  Jaffe  and  Dr.  Gollance  have  had  wide  experience  in  the 
administration  of  methadone  maintenance  programs. 

We  also  have  with  us  today  Robert  F.  Horan,  Commonwealth  at- 
torney for  Fairfax  County,  Va.,  who  will  tell  us  about  the  special 
drug-abuse  problems  of  his  suburban  county. 

We  will  also  hear  from  Dr.  Daniel  Casriel  about  a  new  treatment 
program  for  heroin  addicts  that  employs  a  rapid-acting  detoxification 
drug. 

And,  finally.  Dr.  Gerald  Davidson,  of  Boston  City  Hospital,  will 
explain  the  workings  of  his  program. 

We  hope  that  the  information  we  receive  from  these  witnesses  and 
others  yet  to  appear  will  help  us  formulate  recommendations  to  the 
Congress  on  what  the  Federal  Government  can  do  to  fight  addiction,  in 
addition  to  what  we  are  now  doing. 

(209) 


210 

The  committee  is  pleased  to  call  now  Dr.  Jerome  H.  Jaffe,  a  dis- 
tinguished doctor  and  the  director  of  one  of  the  Nation's  largest  drug- 
abuse  programs. 

Dr.  Jaffe  is  associate  professor  of  psychiatry  at  the  University  of 
Chicago,  and  director  of  the  drug  abuse  program  of  the  Illinois  De- 
partment of  Mental  Health. 

Dr.  Jaffe  holds  both  a  bachelor's  and  master's  degree  in  psychology 
from  Temple  University  and  an  M.D.  from  the  Temple  University 
School  of  Medicine. 

He  has  been  the  holder  of  a  U.S.  Public  Health  Service  Post  Doc- 
toral Fellowship  in  Pharmacology  and  has  twice  received  the  U.S.  Pub- 
lic Health  Service  Career  Development  Award. 

Dr.  Jaffe  is  a  member  of  numerous  scientific  and  honorary  organi- 
zations. He  is  a  member  of  the  editorial  board  of  the  International 
Journal  of  the  Addictions;  a  member  of  the  Review  Committee  of 
NIMH's  Center  for  Studies  of  Narcotics  and  Dangerous  Drugs;  a 
consultant  to  the  Illinois  Narcotic  Advisory  Council  and  the  New 
York  State  Narcotic  Addiction  Control  Commission.  He  also  serves 
as  secretary  of  the  section  on  drug  abuse  of  the  World  Psychiatric  As- 
sociation; a  consultant  to  the  Department  of  Health,  Education,  and 
Welfare;  and  special  consultant  to  the  World  Health  Organization's 
Expert  Committee  on  Drug  Dependence. 

He  is  also  the  author  of  numerous  articles  on  drug  addiction. 

Dr.  Jaffe,  we  are  indeed  pleased  to  receive  your  testimony  today. 

Mr.  Perito,  will  you  inquire  ? 

Mr.  Perito.  Thank  you,  Mr.  Chairman. 

Dr.  Jaffe,  I  understand  that  you  have  a  prepared  statement;  is 
that  correct  ? 

STATEMENT  OF  DR.  JEROME  H.  JAITE,  DIRECTOR,  ILLINOIS 

DRUG  ABUSE  PROGRAM  ^ 

Dr.  Jaffe.  That  is  correct. 

Mr.  Perito.  Would  you  care  to  present  that  to  the  committee  ? 

Dr.  Jaffe.  Yes.  I  would  like  to  comment  briefly  on  four  areas  re- 
lated to  the  problem  of  narcotics  addiction  and  drug  abuse : 

First.  The  spectrum  of  treatment  services  required  to  treat  narcotics 
users,  and  our  experiences  in  the  State  of  Illinois  in  developing  a 
multimodality  program  for  delivering  such  services. 

Second.  A  progress  report  on  acetyl-methadol,  a  drug  that  we  be- 
lieve may  have  significant  advantages  over  methadone  in  the  treatment 
of  heroin  users. 

Third.  Our  current  estimates  on  the  effect  of  treatment  in  reducing 
antisocial  activity. 

Fourth.  My  own  views  on  the  kinds  of  research  that  will  be  re- 
quired if  we  are  to  avoid  another  pandemic  of  drug  use  similar  to  the 
one  we  are  now  experiencing. 

1  Subsequent  to  Dr.  Jaffa's  appearance  before  the  committee.  President  Nixon,  on  June  12, 
1971,  named  Dr.  Jaffe  as  his  chief  consultant  on  drucr  abuse  and  drnp  dependence  and 
proposed  his  name  for  consideration  by  the  Senate  as  Director  of  the  President's  proposed 
Special  Action  OflSce  on  Drug  Abuse  Prevention. 


211 


In  the  State  of  Illinois  our  efforts  to  develop  treatment  programs 
began  in  1966.  Our  approach  to  treatment  was  based  on  a  very  clear 
set  of  premises  and  principles : 

(1)  Narcotic  users  are  a  heterogeneous  group  requiring  different 
treatments. 

(2)  To  determine  which  treatments  were  most  appropriate  for  a 
given  community  required  a  community  diagnosis. 

(3)  Treatment  programs  should  be  located  in  the  communities 
where  patients  lived. 

(4)  No  program,  no  matter  how  sound  it  might  appear  to  be  theo- 
retically or  how  appealing  it  was  emotionally,  would  be  continued 
unless  objective  evaluation  revealed  it  to  be  effective  and  to  justify 
the  expenditure  of  public  funds. 

Initially,  our  program  could  be  called  a  controlled  comparison  of 
several  different  approaches,  somewhat  competitive,  but  friendly.  We 
developed  a  therapeutic  community — Gateway  Houses — modeled  after 
Daytop  Village.  We  explored  the  use  of  narcotic  antagonists  such  as 
cyclazocine ;  we  developed  halfway  houses,  a  specialized  hospital  unit ; 
and  we  used  methadone  for  maintenance  at  both  high  doses  and  low- 
doses. 

Later  we  began  to  wonder  why  it  was  necessary  to  have  a  separate 
unit  for  each  approach.  It  became  obvious  that  such  separatism  was  a 
relic  of  old  rivalries  and  philosophical  disputes  that  had  no  place  in 
a  scientifically  run  and  evaluated  program.  With  some  effort  we  were 
able  to  get  most  of  our  units  to  offer  all  of  the  available  approaches  in 
a  more  or  less  eclectic  fashion. 

In  other  words,  at  a  single  facility  a  patient  could  participate  in  a 
methadone  maintenance  program,  later  withdraw,  live  in  a  residential 
self-regulating  community,  reenter  the  community  at  large  on  an 
abstinent  basis,  or  elect  to  take  cyclazocine  and  in  the  event  of  a 
relapse,  move  back  into  a  residential  facility,  or  if  he  was  holding  a 
job  merely  start  again  on  methadone  on  an  ambulatory  basis.  He 
rnight  then  wait  for  a  number  of  months — until  it  was  his  vacation 
time — move  into  the  facilities  and  then  withdraw  from  methodone. 

Not  every  unit  is  able  to  sustain  specialized  treatment  services.  For 
example,  we  have  one  unit  under  the  leadership  of  Dr.  John  Chappie 
that  specializes  in  the  care  of  addicts  with  serious  medical  problems, 
alcoholism,  psychosis,  and  pregnancy.  Yet  this  unit  serves  the  entire 
network  and  a  patient  who  needs  such  treatment  is  merely  transferred 
without  any  interruption  of  treatment. 

We  believe  that  to  reach  the  majority  of  addicts  it  requires  more 
than  one  approach  or  modality.  We  also  believe  that  we  have  dem- 
onstrated that  all  of  the  modalities  can  be  accommodated  within  a 
single  administrative  structure.  The  advantage  to  this  approach  is 
that  program  planning  and  expansion  can  then  be  based  on  the  results 
of  a  fair  and  uniform  evaluation  system  imposed  by  the  administra- 
tive structure  rather  than  by  emotion,  rhetoric,  and  a  political  trial 
at  arms  in  the  lists  of  the  mass  media.  This  kind  of  eclectic  program 
has  come  to  be  called  the  multimodality  approach. 

Currently  lodged  in  the  department  of  mental  health  and  operated 
with  the  cooperation  of  the  University  of  Chicago,  the  program  con- 


212 

sists  of  a  network  of  21  geographically  distinct  facilities  across  the 
State  serving  more  than  1,600  narcotics  users. 

Our  present  primary  goal  is  to  eliminate  the  waiting  list  so  that 
every  patient  who  seeks  treatment  can  get  it  immediately.  We  have 
enjoyed  the  full  support  of  the  Governor,  the  legislature,  and  the 
department  of  mental  health.  We  should  reach  our  primary  goal  with- 
in the  next  6  months. 

11. 

Almost  from  the  beginning  of  the  work  with  methadone,  it  was 
obvious  that  if  we  expected  patients  maintained  on  methadone  to  lead 
normal,  productive  lives  it  would  be  impossible  to  demand  that  they 
come  to  a  clinic  every  day  in  order  to  ingest  their  medication  under 
supervision.  Eventually  patients  would  have  to  be  permitted  to  take 
their  medication  home,  and  although  we  might  hope  that  95  percent 
of  the  patients  would  not  abuse  this  privilege,  it  would  be  naive  to 
hope  that  there  would  not  be  a  small  minority  who  would  give  away 
or  sell  their  prescribed  medication.  Among  the  potential  solutions 
to  this  problem  would  be  a  longer  acting  methadone-like  drug. 

In  1966,  I  proposed  to  study  one  such  substance,  acetyl-methadol, 
but  the  project  was  shelved  when  I  moved  from  New  York  to  the 
University  of  Chicago. 

After  a  3-year  delay  we  resurrected  the  project  and  last  year  my 
colleagues  and  I  reported  that  acetylmethadol  seemed  to  be  as  effec- 
tive as  methadone  in  facilitating  the  rehabilitation  of  heroin  addicts. 
Advantages  includes  its  longer  duration  of  action  and  its  lower  abuse 
potential.  Its  longer  duration  should  also  mean  reduced  program  oper- 
ating costs  since,  obviously,  you  don't  have  to  give  out  the  medication 
every  day,  but  need  only  give  it  three  times  a  week.  Several  months 
after  our  first  report,  one  of  my  collaborators.  Dr.  Paul  Blachly  at 
the  University  of  Oregon,  sent  us  a  confidential  report  in  which  he 
observed  some  advei-se  side  effects  with  1-acetvl-methadol. 

By  that  time  our  group,  including  Drs.  Charles  Schuster,  Edward 
Senav,  and  Pierre  RenauU  had  alreadv  repeated  our  controlled  dou- 
ble-blind studies  and  had  found  no  such  side  effects ;  since  that  time 
we  have  carried  out  still  additional  studies — so  that  our  total  experi- 
ence includes  well  over  75  patients  studied  for  at  least  4  months.  Thus 
far  our  conclusions  are  the  same — acetyl-methadol  is  as  effective  as 
methadone. 

I  want  to  caution,  however,  tliat  we  have  not  used  very  high  doses. 
We  have  used  it  primarily  and  solely  in  males  and  we  cannot  be 
certain  at  this  point  that  at  such  higher  doses  we  would  not  see  un- 
wanted effects. 

III. 

From  the  bejiinning  of  our  program  one  of  the  criteria  by  which 
we  measured  effectiveness  was  the  extent  to  wliich  treatment  reduced 
antisocial  behavior.  We  have  done  at  least  four  separate  studies  in 
which  we  have  compared  the  &t;lf- reported  arrest  rates  of  patients 
prior  to  treatment  and  their  arrest  rates  during  treatment.  In  every 
one  of  these  studies  we  have  observed  a  very  substantial  drop  in  the 
arrest  rates.  In  some  instances  the  rates  were  reduced  to  one-half  of 
the  pretreatment  rate.  In  others,  the  rates  were  reduced  to  one-third 


213 

of  the  pretreatment  rate.  Until  recently,  we  were  unclear  about  how 
to  evaluate  these  results. 

First,  they  are  considerably  less  dramatic  than  those  reported  by 
other  workers.  However,  this  could  be  due  to  our  policy  of  taking 
all  applicants  regardless  of  our  estimate  of  how  well  they  will  do. 

But  second,  for  technical  reasons,  we  were  unable  to  examine  the 
actual  arrest  records  of  our  patients,  but  were  forced  to  rely  on  their 
own  reports  to  our  legal  unit.  The  only  penalty  for  a  failure  to  report 
an  arrest  was  that  if  it  was  later  reported  the  legal  unit  would  offer 
no  assistance  with  respect  to  that  arrest. 

More  recently  our  program  wrote  a  contract  with  the  University  of 
Chicago  Law  School  to  conduct  an  independent  assessment  of  the 
impact  of  treatment  on  crime. 

Mr.  H.  Joo  Shin  and  Mr.  Wayne  Kerstetter  were  able  to  obtain 
the  arrest  records  of  a  sample  of  a  little  over  200  of  our  patients. 
We  then  gave  them  access  to  all  of  our  data.  Their  findings  are  still 
being  analyzed,  but  thus  far  they  have  found  that  official  arrest  rec- 
ords do  not  record  all  of  the  arrests  that  our  patients  have  had. 

The  study  conducted  by  the  University  of  Chicago  Law  School  re- 
vealed that  prior  to  treatment  this  sample  of  patients  had  recorded  on 
their  arrest  records  approximately  84  arrests  per  100  man-years ;  dur- 
ing treatment,  they  accumulated  only  31  arrests  per  100  man-years. 
Depending  on  how  you  want  to  calculate  the  percentage,  this  would 
be  viewed  as  a  61-percent  reduction  in  arrest  rate.  Self-reported  data 
indicated  that  prior  to  treatment  our  patients  had  148  arrests  per  100 
man-years.  After  treatment  the  arrest  rate  was  76  arrests  per  100 
man-years. 

Thus,  it  appears  that  whether  we  use  arrest  records  or  patients  self- 
reports,  arrest  rates  decrease  dramatically.  We  do  not  have  at  present 
a  more  detailed  qualitative  analysis  of  the  change,  but  we  suspect  that 
the  crimes  committed  by  patients  in  treatment  are  less  impulsive  and 
more  benign. 

IV. 

Lastly,  we  come  to  research : 

It  may  be  that  I  am  too  close  to  the  issue  to  see  it  in  perspective.  To 
a  certain  extent  I  consider  myself  a  displaced  person. 

I  left  my  laboratory  and  my  research  in  order  to  develop  a  much 
needed  program  in  the  State  of  Illinois  and  I  look  forward  to  returning 
to  full-time  research. 

The  projects  that  I  personally  think  deserve  high  priorities  are : 

(1)  Further  studies  on  the  use  of  antagonists  in  facilitating  the 
withdrawal  from  methadone  and  in  treating  young  people  who  have 
begun  to  use  heroin  but  have  not  become  physically  dependent.  We 
need  to  develop  long-acting  forms  of  nontoxic  antagonists. 

(2)  An  expanded  investigation  into  the  safety  and  utility  of  acetyl- 
methadol  and  similar  agents. 

(3)  The  development  of  a  system  under  the  aegis  of  a  health-care 
authority  for  monitoring  trends  in  drug  use  and  addiction  so  that  we 
can  mobilize  earlier  and  more  rationally  to  abort  epidemics. 

(4)  Experiments  to  determine  whether  early  intervention  can  abort 
a  microepidemic. 

(5)  Further  studies  on  the  natural  history  of  the  drug-using  syn- 
dromes; for  example,  we  still  do  not  know  how  many  individuals  stop 
using  various  drugs  spontaneously. 


214 

(6)  Basic  studies  on  the  nature  of  the  biochemical  events  involved 
in  tolerance  and  physical  dependence. 

Research  requires  people.  It  is  simply  inadequate  to  make  money 
available  and  expect  that  trained  and  competent  researchers  -will  ma- 
terialize from  the  ether.  These  individuals  require  support  before  they 
are  ready  to  conduct  their  own  research  and  not  all  of  those  who  re- 
ceive such  support  will  develop  into  able  researchers.  Thus,  some  sup- 
port for  training  of  new  researchers  or  the  retraining  of  researchers 
from  other  fields  is  a  prerequisite  to  a  long-run  attempt  to  conduct  the 
research  I  have  described. 

Thank  you. 

Chairman  Pepper.  That  was  a  very  able  and  comprehensive  state- 
ment. Dr.  Jaffe. 

Mr.  Perito,  do  you  have  any  questions  ? 

Mr.  Perito.  Thank  you,  Mr.  Chairman. 

Dr.  JafFe,  you  started  the  program  in  Illinois  in  1967  ? 

Dr.  Jaffe.  Well,  the  legislature  passed  the  appropriations  bill  and 
it  was  signed  in  August  of  1967.  It  took  us  a  number  of  months  to  find 
out  how  to  use  that  appropriation  because  we  were  an  entirely  new 
agency  in  a  sense. 

We  took  the  first  patient,  under  the  aegis  of  the  Department  of 
Psychiatry  of  the  University  of  Chicago  in  January  1968,  and  that 
began  in  my  own  office  at  the  university.  We  sort  of  got  started  in  an 
unusual  way. 

Mr.  Perito.  You  have  gone  from  one  patient  to  1,590  patients  from 
January  1, 1968,  up  until  the  present  time  ? 

Dr.  Jaffe.  We  have  at  least  doubled  our  patient  load  every  year,  and 
intend  to  double  it  again  this  year.  It  is,  we  think,  a  very  orderly  rate 
of  growth. 

Mr.  Perito.  Does  your  program  or  programs,  rather,  have  a  waiting 
list  at  the  present  time? 

Dr.  Jaffe.  Yes ;  it  has  had  a  waiting  list  from  the  first  day  that  we 
took  in  the  first  patient.  No  matter  how  fast  we  expand,  we  have  al- 
ways had  people  waiting  for  treatment. 

Mr.  Perito.  Your  program  is  the  largest  in  Chicago ;  is  that  correct  ? 

Dr.  Jaffe.  Yes. 

Mr.  Pepito.  Are  there  other  large  programs  working  in  conjunction 
with  yours  ? 

Dr.  Jaffe.  Well,  we  have  no  mechanism  for  monitoring  the  size  of 
other  programs.  Unofficially,  I  think  the  largest  program  that  does 
not  come  under  our  aegis  has  50  or  60  people. 

Mr.  Perito.  Do  you  receive  any  Federal  moneys  for  your  program  ? 

Dr.  Jaffe.  There  is  one  grant  from  the  National  Institute  of  Mental 
Health  to  the  University  of  Chicago. 

Mr.  Perito.  Is  this  a  research  or  a  service  grant  ? 

Dr.  Jaffe.  There  is  a  service  grant. 

Chairman  Pepper.  How  much  Federal  assistance  do  you  receive? 

Dr.  Jaffe.  The  first  year  it  was  about  $450,000  to  $500,000.  It  was 
a  matching  grant.  It  has  decreased  by  10  percent  each  year  thereafter. 

Mr.  Perito.  What  do  you  figure  the  cost  is,  per  patient-year,  to  iim 
your  program  at  the  present  time  ? 

Dr.  Jaffe.  Well,  I  can  give  you  some  exact  figui-es,  but  I  would 
like  to  give  you  some  context  in  which  to  put  them. 


215 

About  20  percent  of  our  patients  are  living  in  a  residential  setting. 
At  present,  we  use  no  traditional  hospitals  at  $80  per  day,  but  we 
have  developed  more  efficient — and  we  think  more  rational — ways  of 
handling  patients  who  are  drug  abusers,  since  for  the  most  part,  cor- 
rectly handled  they  are  not  acutely  ill.  Our  residential  settings  still 
cost  us  about  $10  to  $12  per  patient  per  day,  or  $3,500  per  year. 

Our  outpatient  methadone  program  costs  between  $800  and  $1,500 
per  patient  per  year. 

Again,  I  give  you  this  range  because  the  longer  somebody  is  in 
treatment,  if  they  remain  continuously  in  treatment,  the  less  costly  it 
is  to  treat  them.  Once  they  become  stabilized  they  get  a  job  and  they 
are  functioning  reasonably  well. 

At  that  stage,  it  does  not  take  as  much  personnel  or  staffing  to  main- 
tain that  person  in  a  functioning  state.  So  that  for  a  patient  in  the 
early  stages  of  treatment,  you  have  to  have  more  input.  As  our  pro- 
gram has  matured,  our  outpatient  cost  per  patient  have  actually  gone 
down  in  spite  of  inflation. 

Now,  if  you  want  an  overall  cost  for  treating  1,600  people  with  the 
research  we  have  conducted,  with  our  evaluation  with  our  equipment 
costs,  the  cost  is  a  little  over  $2.4  million  to  treat  1,600  people. 

Again,  I  caution  you  that  we  only  reached  1,600  January  1,  so  you 
are  going  to  look  at  a  mean  patient  load  of  about  1,400  over  an  entire 
year. 

In  a  program  that  is  expanding  it  is  more  rational  to  look  at  the 
projected  cost  when  it  stabilizes.  At  that  point  we  expect  that  resi- 
dential costs  will  be  in  the  neighborhood  of  $3,000  to  $3,500  per  patient 
per  year,  and  outpatient  costs  will  be  about  $1,200. 

Mr.  Perito.  Do  most  of  your  funds  emanate  from  the  State  of 
Illinois? 

Dr.  Jaffe.  The  State  of  Illinois. 

Mr,  Perito.  Do  you  receive  any  money  for  your  program  from  the 
University  of  Chicago  ? 

Dr.  Jaffe.  Only  to  the  extent  that  the  University  of  Chicago  makes 
commitments  to  faculty  people  and  provides  fringe  benefits  to  those 
faculty  people,  and  these  benefits  that  are  very  difficult  to  charge  to 
grants.  In  that  sense  we  are  supported  primarily  by  the  Federal 
grant  and  the  State  of  Illinois. 

On  the  other  hand,  we  sort  of  cannibalize  a  lot  of  the  brainpower 
at  the  University  of  Chicago  and  have  no  way  of  compensating  them 
for  the  unofficial  consultation  time  and  the  time  that  we  take  up  in 
trying  to  plan  strategy. 

Mr.  Perito.  Doctor,  how  large  is  your  staff  at  the  present  time, 
that  is  your  full-time  staff  ? 

Dr.  Jaffe.  Well,  there  are  approximately  135  total  State  positions 
at  this  time.  At  the  university  there  are  perhaps  40  positions.  Our 
program  was  designed  to  maximize  where  possible  community  par- 
ticipation and  the  co-opting  of  whatever  community  resources  could 
be  brought  to  bear  on  this  problem.  Since  there  is  a  great  reluctance 
of  community  people  to  donate  their  time  to  the  State,  we  arrange  to 
contract  with  specifically  developed  not-for-profit  corporations  to  op- 
erate certain  components  of  this  program.  Although  we  evaluate  them 
and  although  we  consider  them  operating  arms  of  the  program,  they, 


216 

in    fact,    constitute    autonomous    or    semiautonomous    not-for-profit 
corporations. 

For  example,  Gateway  Houses  Foundation,  which  now  runs  three 
residential  facilities  for  young  polydrug  users  and  heroin  users,  oper- 
ates on  a  contract  with  us  and  Gateway,  I  believe,  employs  18  staff 
people. 

We  have  several  other  small  organizations  that  are  contracting  with 
those. 

I  would  guess,  in  the  aggregate,  their  staff  may  come  to  a  total  of 
perhaps  30  people.  So  that  if  you  want  to  total  it  all-  up  it  is  perhaps 
about  220  people,  give  or  take  a  few,  to  take  care  of  this  patient  load. 

Mr.  Perito.  Doctor,  in  your  prepared  statement  you  mentioned  the 
use  of  acetyl-methadol.  Do  you  foresee  that  this  long-lasting  drug  will 
someday  be  a  replacement  for  methadone? 

Dr.  Jaffe.  Not  entirely  as  a  replacement  for  methadone.  Any  new 
drug  has  its  advantages  and  disadvantages. 

First,  I  would  like  to  emphasize  that  acetyl-methadol  requires  fur- 
ther study.  It  may  very  well  be  that  an  attempt  to  use  it  at  much 
higher  doses  would  cause  some  side  effects.  Furthermore,  it  is  a  drug 
whose  primary  advantage  is  its  long  duration  of  action.  This  means 
that  it  is  a  drug  that  can  be  given  three  times  a  week.  No  drug  need 
be  taken  home  and  therefore  no  drug  can  be  illicitly  diverted.  It  has 
its  advantages. 

Mr.  WiGGixs.  Doctor,  who  developed  this  drug  ? 

Dr.  Jaffe.  This  drug  has  been  around  since  the  1950's.  It  was  origi- 
nally developed  by  Merck,  tested  at  Lexington,  but  because  it  was  so 
long  acting  there  was  no  further  use  for  it  in  medicine.  I  was  about 
to  say  its  advantage  turns  out  to  be  its  disadvantage.  Many  people  are 
not  familiar  with  a  drug  that  should  not  be  given  every  24  hours. 
If  you  give  it  every  24  hours  you  get  cumulative  toxicity,  the  drug 
lasts  for  several  days,  so  that  you  have  some  overlap.  Before  this  drug 
can  be  widely  used  it  will  take  an  educational  program. 

Mr.  Wiggins.  You  make  an  interesting  point,  and  that  is  drugs  that 
are  really  effective  sort  of  price  themselves  right  out  of  the  market, 
don't  they,  because  there  is  no  longer  a  need  for  them  if  they  solve 
the  problem  that  they  are  created  to  solve?  Is  that  really  what  you 
are  saying  here  about  this,  that  it  was  so  effective  that  there  was  no 
market  for  it  ? 

Dr.  Jaffe.  No;  I  am  saying  it  was  tested  as  an  analgesic  agent,  a 
painkiller,  and  in  some  instances  people  were  unaware  that  this  was 
a  drug  that  should  not  be  given  every  day.  When  they  gave  it  every 
day  some  patients  developed  cumulative  toxicity.  In  effect,  by  taking 
it  every  day  they  received  overdoses.  This  made  it  virtually  useless 
as  an  analgesic.  It  was  just  too  tough  to  use. 

Mr.  Wiggins.  This  drug  was  developed  by  a  private  pharmaceu- 
tical house  ? 

Dr.  Jaffe.  That  is  correct. 

Mr.  Wiggins.  For  sale  for  profit,  I  take  it  ? 

Dr.  Jaffe.  It  never  reached  the  market  in  any  meaningful  way. 

Mr.  Wiggins.  Are  you  satisfied  that  we  can  or  should  rely  i:)rimarily 
on  the  private  researchers  and  pharmaceutical  houses  to  develop  a 
drug  that  you  may  need  ? 

Dr.  Jaffe.  No. 


217 

Mr.  Wiggins.  "\Yliere  else  is  it  being  done  or  should  it  be  done  ? 

Dr.  Jaffe.  Well,  my  experience  has  been  that  we  do  not  have  an 
effective  mechanism  for  developing  drugs  which  don't  have  a  poten- 
tially significant  commercial  market.  Drug  houses  do  not  want — and 
at  least  in  my  own  experience — to  develop  drugs  which  have  no 
market,  utilizing  their  own  resource  and  their  own  personnel  and  their 
own  laboratory  facilities. 

On  the  other  hand.  I  think  we  have  precious  little  in  the  way  of  that 
kind  of  resource  within  the  public  sector.  Generally,  universities  are 
not  in  the  business  of  developing  drugs. 

Mr.  WiGGixs.  What  suggestions  might  you  make  to  the  committee 
if  we  are  interested  in  encouraging  the  development  of  such  drugs? 

Dr.  Jaffe.  Well,  I  am  not  sure  that  I  know  enough  about  the  devel- 
opment of  pharmaceutical  preparations  to  make  really  meaningful 
suggestions  on  it.  I  suspect  there  is  some  difficulty  with  respect  to 
patent  problems.  As  soon  as  you  give  subsidies  to  a  commercial  or- 
ganization, it  then  loses  the  possibility  of  distributing  and  marketing 
that  product  for  profit. 

Mr.  Wiggins.  Well,  could  it  be  done  alternatively  or  together  at  the 
National  Institutes  of  Health  or  at  universities  operating  under 
grants  ? 

Dr.  Jaffe.  I  think  it  could  be,  but  traditionally  universities  have 
not  been  in  the  drug  development  business  and  it  would  mean  think- 
ing about  what  would  be  necessary  to  develop  that  capacity  within 
a  university.  J 

The  difficulty  with  many  universities,  at  least  until  recently,  is 
that  Govermnent  encourages  universities  to  apply  for  grants  that 
run  for  3  or  4  years.  The  university  recruits  people  and  brings  them 
from  wherever  they  were  to  the  university.  Their  families  are  there. 
And  then  the  grants  run  out.  The  Government  just  says,  well,  we  have 
other  priorities  now.  The  university  is  left  with  the  problem  of  staff 
people  who  nobody  wants  any  more.  They  are  surplus.  This  is  a  hu- 
man problem. 

If  the  university  doesn't  teach  the  development  of  pharmaceutical 
products,  then,  you  know,  it  is  very  difficult  to  get  it  involved  in  de- 
veloping this  kind  of  thing. 

There  are,  you  know,  schools  of  pharmacy,  but  whether  or  not  they 
are  in  the  business  of  developing  drugs,  I  can't  say.  The  development 
of  new  pharmaceuticals  is  npt^^y  area^of  expertise. 

Mr.  Wiggins.  All  right.     '  -v    ...^  ., ^  r  ( ^  ■•  r^^  ^ 

Chairman  Pepper.  Excuse  me;"^,,  ^. 

Apropos  to  what  Mr.  Wiggins  was  asking  you,  the  suggestion  was 
made  the  other  day  that  it  might  be  possible  for  the  U.S.  Government 
to  give  grants  to  drug  houses  to  carry  on  approved  research  in  areas 
where  the  Government  desired  such  research  be  carried  on,  with  the 
understanding  that  if  the  company  ever  profited  from  the  distribu- 
tion of  that  drug,  the  United  States  would  get  its  money  back,  and  in 
that  way  you  would  allow  the  company  to  retain  the  ownership  of 
the  patent  while  reimbursing  the  Government  should  the  research 
produce  a  drug  that  is  economically  profitable.  , 

Dr.  Jaffe.  That  sounds  like  a  very  creative  approach  to  me.  I  won- 
der whether  or  not  it  can  be  accomplished.  Certainly  it  is  the  first 
time  I  have  heard  that  suggestion.  I  know  it  has  been  a  stumbling 
block  for  most  pharmaceutical  houses. 

60-296— 71— pt.  1 15 


218 

Chairman  Pepper.  Mr.  Perito? 
;;    Mr.  Perito.  Thank  you.  Mr.  Chairman.  I  have  a  couple  of  more 
questions  along  that  line  for  Dr.  Jaft'e's  consideration. 

You  had  mentioned  earlier  during  staff  interviews  that  one  of  the 
problems  was  in  developing  new  research  techniques  involving  possi- 
ble development  of  antagonists  that  researchers  become  terribly  spe- 
cialized, but  then  when  the  problem  is  solved  there  is  no  need  for  them 
any  longer. 

I  wonder,  could  you  expand  upon  this  for  the  committee's  benefit? 

Dr.  Jaffe.  Yes;  my  point  was  simply  that  I  think  the  situation  is 
somewhat  analogous  to  the  space  program.  If  Government  decides  it 
has  a  priority  and  wants  to  have  a  crash  program,  we  can  give  out  a 
great  deal  of  money  and  get  people  to  drop  a  secure  position  where  they 
are  teaching  something  or  doing  research  on  something  which  has 
long-range  value.  Those  people  come  into  the  field  and  they  get  in- 
volved in  the  crash  progi'am.  As  soon  as  the  problem  is  solved,  they  are 
out  of  business,  and  it  is  a  human  problem.  I  think  it  causes  some  re- 
luctance for  the  best  people  to  drop  their  work  and  get  involved  in  it. 

What  you  often  get  with  this  kind  of  crash  interest  is  that  you  move 
marginal  people  who  haven't  done  well  in  more  traditional  fields  than 
this,  which  is  precisely  what  won't  get  the  job  done.  I  have  no  specific 
suggestions  as  to  how  to  get  the  job  done.  I  think  it  remains  a  problem 
for  Government  to  examine  what  it  does  about  its  human  excess  bag- 
gage, particularly  when  that  excess  baggage  turns  out  to  be  its  best 
brainpower  that  it  recruits  into  solving  public  problems  and  then 
abandons. 

I  can  say  for  myself  that  at  this  point  I  would  have  to  stop  for  a 
number  of  months  to  review  the  literature,  to  prepare  a  grant  applica- 
tion, to  get  caught  up  with  a  research  field  in  order  to  get  a  grant. 
Since  I  moved  into  the  public  service  sector  in  order  to  develop  a 
delivery  system  that  made  use  of  known  research  which  existed  in 
1967  and  1968  I,  at  least,  have  a  university  base.  Other  researchers 
may  not  have  such  an  affluent  base — I  am  not  sure  our  university  is 
affluent — but  at  least  universities  are  willing  to  make  that  commit- 
ment of  saying,  "You  may  now  sit  back  and  get  caught  up  with  your 
own  field  in  order  to  compete  for  a  grant." 

This  is  the  difficulty.  You  move  people  into  one  thing,  then  you  want 
them  to  switch.  Nobody  supports  them  during  that  interval  while 
they  are  trying  to  reacquire  the  tools  and  get  caught  up  with  the  tech- 
nology in  order  to  compete  for  other  grants. 

We  certainly  have  gutted  the  universities  in  many  respects  with 
respect  to  their  capacity  to  support  people.  They  are  very  dependent 
on  research  grants.  When  these  things  are  cut  back  they  have  no  way 
of  supporting  those  people  who  then  are  looking  to  find  out  what  are 
the  new  areas  that  are  of  interest  to  the  public. 

Mr.  Perito.  Have  you  found  an  appreciable  difference  on  your  crime 
studies  and  the  efficacy  of  your  program  in  reducing  crime  or  anti- 
social behavior?  Have  you  found  a  principal  difference  betAveen  the 
arrest  records  that  you  have  checked,  and  the  actual  instances  of  crimi- 
nal behavior  that  you  have  found  out  through  interviews  with  addicts? 

Dr.  Jaffe.  Well,  I  can  say  that  our  interviews  with  addicts  indicate 
that  a  great  deal  of  crime  occurs  that  is  not  reflected  in  an  arrest.  It  is 
a  very  interesting  kind  of  thing.  'V^Tien  we  establish  rapport  with 


219 

somebody  who,  almost  as  a  professional,  engages  in  antisocial  activity, 
they  will  be  very  honest  with  you. 

We  have  seen  that  when  we  get  people  into  treatment,  even  A\-hen 
they  don't  give  up  their  antisocial  activity  entirely  in  the  early  months 
of  treatment — and  get  a  legitimate  paying  job — their  antisocial  activity 
still  drops  dramatically.  They  may  not  be  arrested  at  all,  yet  we  know 
they  are  committing  crimes.  Nevertheless  they  are  committing  them 
at  half  the  rate  they  were  committing  thom.  So  that  sometimes  you 
can  get  a  great  deal  by  talking  to  people  that  the  arrest  records  will 
not  reveal. 

The  arrest  records  are  only  a  very  approximate  index  of  what  is 
actually  happening.  There  are  discrepancies  and  they  go  in  both  direc- 
tions. Sometimes  people  who  commit  virtually  no  ciime  manage  to 
get  arrested  for  some  charge  anj^way,  and  somebody  else  who  is  more 
skilled  continues  to  engage  in  antisocial  activities  for  long  periods  and 
is  not  arrested  at  all.  We  have  seen  both  of  these  kinds  of  things  go  on. 

Mr.  Perito.  Do  you  regard  the  coiicept  of  narcotic  antagonists  like 
cyclazocine  and  naloxone  as  a  hopeful  aiea  in  multimodalit}'  approach '{ 

Dr.  Japfe.  Do  I  regard  the  concept  of  narcotic  antagonists  as  a  hope- 
ful area  ?  The  answer  is  that  I  do. 

HoAvever,  as  I  said  several  3'ears  ago,  it  is  quite  clear  that  in  order 
to  be  effective  in  treating  narcotics  users  a  more  appropriate  form  of 
narcotic-antagonist  will  be  required.  We  will  require  an  antagonist 
with  minimal  side  effects  that  can  be  given  in  a  way  that  will  produce 
a  blockade  of  narcotic  effects  for  at  least  several  days.  Unlike  metha- 
done, patients  don't  want  to  come  back  to  a  clinic  every  day  just  to 
take  a  drug  that  blocks  narcotic  effects. 

Some  will.  Some  will  for  a  number  of  months,  but  for  the  most 
part,  after  a  few  months  they  are  convinced  they  don't  need  the  an- 
tagonist any  more,  so  they  stop. 

Chairman  Pepper.  Excuse  me  a  moment. 

The  effect  of  this  antagonist  drug  is  to  prevent  them  from  getting 
any  sensation  of  satisfaction  or  euphoria  from  the  taking  of  heroin? 

Dr.  Jaffe.  That  is  correct. 

Chairman  Pepper.  Now  then,  could  you  add  to  that  drug  the  quality 
of  making  the  taking  of  heroin,  again  within  a  reasonable  time,  repul- 
sive to  the  system;  that  is,  causing  a  reaction  of  an  unfavorable 
character? 

Dr.  Jaffe.  I  am  not  sure  that  we  have  such  a  drug,  nor  am  I  really 
certain  that  it  would  be  useful.  It  would  be  interestmg  if  we  had  one, 
but  you  see,  they  do  have  something  comparable  to  that  in  alcoholism 
with  Antibus.  and  the  results  have  not  been  overly  dramatic.  If  the 
revulsion  reaction  is  severe  enough  it  may  be  endangering  somebody's 
life  and  you  have  an  ethical  question. 

The  antagonists  have  the  advantage  that  you  can  perhaps  persuade 
somebody  to  become  involved  with  the  antagonists,  because  it  will  not 
hurt  him  if  he  takes  a  narcotic.  It  merely  blocks  the  effect. 

Obviously,  what  it  does  not  do  is  in  any  way  allay  this  kind  of 
narcotic  hunger,  this  craving  that  some  addicts  seem  to  feol  when 
they  are  not  actively  using  or  during  the  first  year  or  so  after  they 
stop  taking  narcotics. 

I  want  to  get  back  to  your  question  about  naloxone  and  cvclazocine. 
Cyclazocine  I  think  we  have  explored.  It  is  a  difficult  drug  to  use.  It 


220 

is  not  a  very  forgiving  drug.  Its  side  effects  require  that  the  treaters 
have  a  considerable  degree  of  skill.  It  still  lasts  only  24  hours.  Given 
the  effort  required  and  given  the  level  of  patient  acceptance,  I  don't 
think  cyclazocine  is  a  drug  that  in  its  present  form  we  can  hope  to 
see  widely  employed. 

Naloxone  is  a  very  promising  substance,  theoretically,  in  that  it  has 
no  side  effects  at  all.  For  most  people  it  is  entirely  inert.  The  problem 
is  that  it  is  not  very  effective  orally  and  it  is  short  acting.  Its  cost  is 
such  that  even  if  you  wanted  to  take  it  every  day  in  huge  quantities,  it 
would  probably  cost  as  much  as  the  heroin  habit  that  you  are  trying 
to  treat.  Therefore,  naloxone  in  its  present  dosage  form,  to  me,  is  not 
a  very  useful  or  a  hopeful  approach.  ■  r  ■ 

I  might  say  that  our  hope  lies  with  the  entire  family  of  narcotics 
antagonists,  and  there  are  literally  dozens  that  could  be  investigated, 
one  of  which  I  am  sure  will  be  extremely  potent,  orally  effective,  and 
have  minimal  side  effects. 

If  that  then  proves  to  be  promising  it  could  be  converted  into  some 
kind  of  dosage  form  that  might  be  effective  for  at  least  several  days 
or  weeks. 

This  is  a  matter  of  product  development.  I  am  sure  it  can  be  done  if 
people  are  willing  to  put  the  effort  into  it. 

Chairman  Pepper.  And  the  money. 

Do  you  think  it  would  be  in  the  public  interest  for  the  Federal  Gov- 
ernment to  expand  its  research  funds  to  encourage  the  appropriate 
people  to  develop  those  leads  that  you  are  talking  about  ? 
o  Dr.  Jaite.  I  think  if  we  do  not  look  into  them  we  will  be  remiss. 

Chairman  Pepper.  Mr.  Blommer,  do  you  have  any  questions  ? 

Mr.  Blommer.  Thank  you,  Mr.  Chairman. 

Doctor,  I  believe  Dr.  Dole  of  New  York  has  said  he  believes  that 
about  25  percent  of  the  heroin  addicts  in  New  York  would  benefit  from 
methadone  maintenance.  I  wonder  if  you  could  comment  on  that  state- 
ment and  tell  the  committee  what  type  of  heroin  addict  you  believe 
should  be  put  into  a  methadone-maintenance-type  of  program  ? 

Dr.  Jaffe.  Well,  I  will  comment  first  on  the  25  percent.  I  don't  know 
how  Dr.  Dole  obtained  his  figure,  but  we  came  out  with  almost  the 
same  figure,  based  on  a  very  empirical  2-year  study  of  heroin  users  in 
the  Chicago  area.  ^ 

In  other  words,  we  admitted  everybody  who  came.  If  you  came  to 
the  door,  you  were  admitted.  We  thought,  based  on  epidemicologic 
studies  in  the  commounity,  that  about  half  of  known  active  narcotics 
users  would  seek  treatment,  and,  of  those,  over  tlie  long  run  about  lialf 
would  obtain  substantial  benefits.  So  half  of  half  is  25  percent.  This 
is  based  on  or  data  of  several  years  and  several  thousand  patients. 

What  kind  of  patient  would  benefit  is  much  more  difficult  to  answer:, 
because  it  is  very  hard  to  predict.  ^  - ' 

Mr.  Wiggins.  I^et  me  interrupt,  because  I  want  to  get  somethilig^^^ 
my  mind.  >  i      ■  m 

Dr.  Jaffe.  Yes,  sir. 

Mr.  Wiggins.  Would  you  say  that  any  person  who  is  inclined  to 
take  heroin  would  be  better  off  taking  methadone  instead  of  heroin  ? 

Dr.  Jaffe.  I  am  not  sure  what  you  have  in  mind  when  j-ou  say  any 
person  inclined  to  take  heroin. 


22l 

"''Mr.  Wiggins.  A  lot  of  people  are  inclined  to  take  heroin  for  very 
poor  reasons,  but  they  do  it,  nevertheless.  Is  methadone  better  than 
heroin  t 

Dr.  Jaffe.  Well,  oral  methadone  is  a  lot  safer  than  heroin  bought 
from  a  pusher  on  the  street  without  any  question.  If  I  had  someone 
absolutely  committed  to  finding  out  how  a  narcotic  drug  felt  and 
you  presented  me  only  two  alternatives,  either  they  wanted  to  buy 
some  heroin  on  the  street,  cook  it,  or  take  a  swallow  of  oral  methadone, 
I  think  the  answer  would  be  obvious.  They  would  be  a  lot  better  off 
and  safer  taking  methadone.  But  I  don't  know  if  that  is  what  you 
are  driving  at.  . 

Mr.  Raxgel.  Let  me  ask  this :  Would  your  answer  be  the  same  it 
the  heroin  was  being  taken  orally,  notwithstanding  the  difference  m 
reaction? 

Dr.  Jaffe.  No;  if  these  were  known  dosages  of  heroin  and  metha- 
done, both  taken  orally,  I  don't  think  that  it  really  makes  much  ciiffer- 
ence  at  all. 

Mr.  RaXgel.  Would  it  make  much  of  a  difference  if  the  methadone 

were  injected? 

Dr.  Jaffe.  Oh,  yes.  Injectable  narcotics  produce  some  very  rein- 
forcing effects  in  the  sense  that  you  can  do  research  on  animals  and 
you  can  show  that  animals,  given  an  opportunity  to  inject  _  intra- 
venously any  one  of  the  narcotics,  learn  very  quickly  to  keep  injecting 
those  drugs. 

Mr.  Waldie.  Doctor,  may  I  interrupt  you  at  this  moment  ? 

In  response  to  Mr.  Wiggins  and  Mr.  Rangel's  question,  I  under- 
stood you  to  say  that  if  you  had  the  same  control  over  heroin  in  terms 
of  quantity  and  the  manner  in  which  it  is  administered  as  you  have 
over  methadone,  the  man  taking  heroin  would  be  ill  no  better  or  worse 
position  than  the  man  taking  methadone  ? 

Dr.  Jaffe.  No.  The  question  was  in  response  to  a  single  dose. 

Further,  j'ou  are  talking  about  chronic  administration. 

Mr.  Waldie.  Let  me  phrase  the  question  this  way,  then :  There  is  a 
concern  among  some  people,  and  I  share  it,  that  we  are  substituting 
one  addictive  drug  for  another.  Is  there  some  advantage  to  that  sub- 
stitution, to  substitute  methadone  for  heroin,  other  than  the  advan- 
tages that  you  have  stated,  that  there  might  be  an  infection  because  of 
the  intravenous  injection  and  there  might  be  adverse  effects  because 
of  the  impurity  of  the  heroin  ? 

Dr.  Jaffe.  Oh,  yes.      . 
):Mr.  Waldie.  Are  there  other  results  that  are  beneficial  for  use  of 
methadone  rather  than  heroin  ? 

Dr.  Jaffe.  In  our  present  context,  without  a,nj  question.  There  are 
two;  ■''      ■    ' 

First  of  all,  the  oral  absorption  of  heroin  is  somewhat  erratic.  Fur- 
thermore, the  drug— and  I  am  not  sure  this  has  been  studied  in  de- 
tail— is  probably  not  even  in  significant  quantity  going  to  have  smooth 
duration  of  action  if  you  were  to  give  it  once  a  day  under  observation. 
:  1  mean,  if  you  were  still  in  the  position  of  looki'^o-  for  something 
which  lasts  24  hours,  of  letting  peonle  take  it  home  for  their  own  use. 
As  soon  as  you  begin  letting  people  take  it  home  to]H,have  trouble 
with  illicit  diversion  and  accidental  ingestion.  ■■' 

"ff !    y  rfCMJoefiii  Y<  •:  ;o  ii.Mcj  v.-'I'. 


222 

Furthermore,  in  our  present  context  we  are  deeply  concerned  about 
tlie  intravenous  use  of  illicit  heroin.  The  use  of  methadone  provides 
one  very  pragmatic  possibility  of  knowing  when  patients  continue  to 
use  illicit  heroin.  In  our  program,  patients  on  methadone  have  their 
urine  tested.  We  know  a  patient  is  taking  heroin  in  addition  to  metha- 
done. If  we  weren't  giving  them  methadone — but  were  giving  them 
oral  heroin — we  would  have  no  way  of  knowing  whether  they  continue 
to  take  intravenous  illicit  heroin. 

Mr.  Waldie.  Let  me  ask  one  question.  Are  the  results  on  the  indi- 
vidual of  taking  methadone  less  debilitating  than  the  results  on  the 
individual  of  taking  heroin  ? 

Dr.  Jaffe.  Let  me  try  to  state  this  as  precisely  as  I  can. 

Mr.  Wiggins.  That  is  a  clinical  setting,  right  ? 

Mr.  Waldie.  Eight. 

Dr.  Jaffe.  No  one.  to  my  knowledge,  has  done  adequate,  careful, 
controlled  studies  of  large  doses  of  oral  heroin.  So  we  are  always 
forced  to  compare  the  British  experience  with  self -administered  in- 
travenous heroin  with  our  own  experience  of  regular  administration 
of  oral  methadone. 

So  the  two  situations  are  not  comparable. 

To  the  best  of  our  knowledge,  intravenous  heroin  is  not  a  good  drug 
sociologically  or  psychologically,  because  the  ups  and  downs  of  a 
short-acting  drug  get  people  going  from  a  "high"  to  a  little  bit  "sick" 
and  then  they  want  to  be  high  again.  It  is  not  a  drug  permitting  easy 
stabilization  and  functioning — the  stabilization  of  the  kind  that  lets 
citi7:ens  take  care  of  business. 

Methadone  does  permit  that  when  used  orally. 

Mr.  Brasco.  May  I  ask  one  question  ?  You  sort  of  confused  me  as  to 
what  was  said,  at  least  as  I  understood  it,  by  Dr.  Gearing  yesterday 
when  we  spoke  about  taking  heroin  orally. 

If  I  understand  correctly.  Dr.  Gearing  said  there  would  be  no  effect. 
Exactly  what  is  the  effect  of  taking  heroin  orally  ? 

Dr.  Jaffe.  Taking  heroin  orally  ? 

Mr.  Brasco.  Yes ;  has  it  the  same  effect  that  you  get  when  you  use 
it  intravenously  ? 

Dr.  Jatte.  No. 
'  Mr.  Brasco.  What  effect  does  it  have  ? 

Dr.  Jaffe.  Well,  the  effect  you  get  when  you  take  a  drug  intraven- 
ously, a  very  short  onset  of  action. 

Mr.  Brasco.  No ;  I  am  talking  about  taking  heroin  orally. 

Dr.  Jaffe.  Heroin  was  given  orally.  It  was  used  in  this  country  until 
about  5  or  10  years  ago  when  we  ran  out  of  old  stocks  for  cough 
medicine. 

Mr.  Brasco.  I  understood  her  to  say — and  maybe  I  am  laboring 
under  a  misapprehension — that  if  you  take  it  orally  there  was  basically 
no  effect. 

Dr.  Jaffe.  From  oral  heroin  ? 

INIr.  Brasco.  Right ;  as  opposed  to  taking  the  methadone  orally,  you 
would  have  the  stabilizing  effect  and  it  would  prevent  the  cra\nng  for 
the  heroin.  "When  you  take  the  heroin  orally,  I  got  the  impression  that 
you  were  sort  of  in  the  same  position  as  not  having  taken  it. 

Dr.  Jaffe.  Well,  I  think  you  are  asking  two  different  questions.  One 
is:  Is  heroin  as  effective  a  drug  taken  orally  as  by  injection?  The 


223 

answer  is  that  its  oral  to  parental  ratio  is  not  as  high,  meaning  that 
it  takes  a  lot  of  heroin  orally  to  give  you  a  blood  level  so  that  you 
get  an  effect.  That  is  also  true  of  morphine.  It  is  also  true  of  many 
of  tlie  standard  narcotics  tliat  we  use  in  medicine. 

If  somebody  really  has  pain,  you  would  have  to  give  them  a  shot 
of  a  drug  like  morphine.  Methadone  is  one  of  the  few  drugs  in  the 
narcotic  analgesic  group  that  has  a  good  oral  potency,  meaning  that 
you  don't  have  to  give  a  tremendous  amount  of  it  by  mouth  to  have 
an  effect. 

Mr.  Brasco.  As  a  practical  matter,  what  would  one  take  heroin 
orally  for? 

Dr.  Jaffe.  The  same  way  you  take  codeine,  you  give  a  little 

Mr.  Brasco.  We  are  talking  about  people  addicted  to  drugs. 

Dr.  Jaffe.  Nobody  would  ever  take  lieroin  orally  if  they  were  ad- 
dicted. It  is  too  inefficient.  People  sniff  it,  some  people  smoke  it,  but 
probably  nobody  would  swallow  it,  simply  because  it  is  not  efficient. 
The  body  metabolizes  it  before  it  gets  a  chance  to  be  active. 

Chairman  Pepper.  Mr.  Waldie,  have  you  any  questions? 

Mr.  Waldie.  Just  one  question.  Dr.  Jaffe.  If  the  Federal  Government 
were  to  participate  in  some  way  in  this  whole  problem  with  which 
you  have  been  involved,  would  you  discuss,  No.  1,  the  areas  in  which 
you  think  our  participation  would  be  most  beneficial ;  and  No.  2,  would 
you  believe  in  terms  of  priorities  of  expenditure,  which  would  be  the 
nature  of  our  participation,  that  there  is  one  portion  of  this  program 
that  is  more  deserving  of  expenditure  than  other  portions?  Could 
you  comment  on  those  two  areas  ? 
, .  Dr.  Jaffe.  WTiich  program  are  you  referring  to  ? 

Mr.  Waldie.  I  don't  know.  I  want  you  to  tell  me.  I  want  to  to  tell 
me  what  the  Federal  Government,  in  your  view,  should  interest  them- 
selves in  most  in  terms  of  priority  or  expenditures. 

Dr.  Jaffe.  Well,  in  the  entire  area  you  could  divide  it  into  things 
like  direct  support  of  treatment,  development  of  research  directed 
toward  the  development  of  treatment  and  control  systems,  direct  con- 
trol of  drug  availability  and  training ;  training  both  for  research  and 
treatment. 

Now,  obviously  there  are  some  areas  that  you  could  say  need  priority. 
Our  experience  has  been  that  patients  who  are  chronic  heroin  users 
who  want  treatment  with  methadone  should  be  given  that  treatment, 
because  it  is  better  for  them  and  everybody  in  the  community,  and 
therefore  that  should  be  a  high  priority  for  the  Federal  Government 
to  see  that  the  funds  are  there  to  provide  sensible,  rational  treatment. 

Now,  if  there  are  other  treatment  areas  that  can  be  demonstrated  to 
be  effective  for  those  people  for  whom  we  will  say  methadone  is  not 
effective,  such  as  young  polydrug  users  who  have  not  been  on  drugs 
very  long,  people  who  just  don't  want  to  be  on  methadone,  people 
who  want  to  come  off  methadone.  In  our  experience  many,  many  peo- 
ple feel  they  have  had  their  lives  stabilized,  they  would  like  to  come 
off.  Such  treatments  should  be  provided  or  developed  if  they  do  not 
now  exist.  That  should  be  done  and  the  Federal  Government  should 
see  that  they  provide  that. 

There  are  some  problems  in  communities.  I  cannot  speak  officially 
for  any  State  or  community,  but  I  do  know  there  are  certain  obliga- 
tory expenditures  they  cannot  get  out  of.  I  read  in  the  paper  that  wlien 


224 

the  Federal  Government  decides  it  -svill  not  support  welfare  or  some- 
tliin^  else,  the  State  must  do  that,  and  therefore  it  can  only  trim  op- 
tional kinds  of  things,  mental  health,  treatment  of  addiction,  and 
education. 

So  that  the  Federal  Government  has  to  realize  that  as  it  shifts  its 
priorities,  the  States  are  in  a  reciprocal  relationship.  Communities 
also  set  priorities  and  traditionally  these  treatment  programs  have 
been  viewed  as  optional;  that  is,  it  is  optional  rather  than  legally 
required  that  there  will  be  narcotic  treatment  programs. 

Mr.  Waldie.  One  final  question.  Doctor. 

Do  we  have  enough  experience  yet  to  knoAv  whether  it  is  more 
difficult,  at  first,  to  an  indi^ndual  in  setting  off  of  methadone  addiction 
thn  n  heroin  addiction,  for  example  ? 

Dr.  Jaffe.  The  withdrawal  syndrome  from  heroin,  given  the  doses 
that  most  people  use  in  the  street,  is  pretty  much  a  thing  that  is  over  in 
a  matter  of  a  few  days.  The  difference  is  that  the  relapse  rate  is  phe- 
nomenally high.  Certainly  people  who  withdraw  from  methadone  are 
complaininir  mildly,  but  somewhat  longer.  It  is  dragged  out.  ovqi:  a 
period  of  weeks  or  so.  ?fj',  .;:i(f,v. //  .'ija 

Howei^er.  our  experience  has  been  when  you  stabilize  someone  on 
methadone  and  he  has  gotten  to  the  point  where  he  has  a  job  and  is 
back  with  his  family,  and  thei-e  are  a  number  of  social  supports,  and 
he  has  been  accepted  by  the  community  as  a  responsible  citizen  he 
may  have  a  tougher  time  when  he  withdraws  from  methadone  in  the 
sense  that  it  is  sort  of  a  dragged-out  situation,  but  the  probabilties 
of  being;  able  to  remain  stable  may  be  slightly  higher. 

I  don't  think  enough  work  has  been  done  as  yet  with  trying  to  take 
people  off  methadone  to  try  to  answer  that  question  in  any  definitive 
wav;  It  is  one  of  the  research  areas  tliat  will  deserve  attention. 

Mr.  Waldie.  Thank  you. 
'Chairman  Pepper.  Mr.  Wiggins. 

Mr.  WiGGT^rs.  Doctor,  I  want  to  commence  vHth  a  hypothetical 
question.  Let  us  suppose,  hypothetically,  that  methadone  were  totally 
substitued  in  our  drug  culture  foi'  heroin,  but  that  it  was  used  in  exactly 
the  same  way,  the  shooting  of  it,  using  dirty  needles,  cutting  of  it. 
using  impurities  ond  other  things,  let's  suppose  it  happened  that  there 
was  a  total  substitution  in, that  war  for  heroin:  would  we  be  better 
off  or  worse  off?  ^f^^^V-  ''''  ''^'''"■''  '" ''  '■'  '/^"'-  ''■''^[^  '[■■■'"'. 

^  Dr.  JAffe. '"N'o;  the  advantages  of  methadone  are  not  nearly  as 
pharmacologibally — — 

Mr.  Wiggins.  Just  respond  to  that  question,  better  off  or  worse  off? 

Dr.  Jaf*t..  We  %oiild  be  no  better  off.  T  don't  think  we  would  be  any 
worse  off.  It  is  hard  to  picture  a  situatioh  niuch  woi'se  off. 

The  advantage  of  the  present  situation  is  as  mnch  in  the  system  by 
which  the  methadone  is  controlled — its  supervision — as  in  its  "pharma- 
cological differences.  ^  ^^  .oifohKO  loi.t  !.■   oi,i  v-  -;  ^." 

INIr.  Wiggins.  I  tliink  it  is  an  important  question,  because  conceiv- 
ably we  could  end  up  in  that  position.  T  would  think  there  is  a  ])ossi- 
bility  we  might  be  better  oft'.  At  least  the  narcotic  would  be  produced 
by  local  manufacturers  who  would  be  subject  to  somewhat  more  con- 
trol than  Turkish  farmers.  Perhaps  the  Mafia  or  some  other  organized 
criminal  activity  would  not  be  so  intimately  involved  in  its  distribu- 
tion. These  may  not  be  insignificant  advantages. 


99; 


zo 


Dr.  Jaffe.  I  would  say  that  I  can't  conceive  of  a  situation,  in  know- 
ing what  we  laiow,  where  we  would  permit  the  situation  to  deterior- 
ate to  the  point  that  methadone  would  be  that  readily  available  for 

intravenous  use.  M'^-rr^  n  >■•■■. 

Mr.  WiGGixs.  Many  of  us  have  harbored  the  suspicions,  at  least, 
that  metliadone  programs  proceeded  from  the  assumption  that  the 
only  way  to  take  crime  out  of  a  drug  business  is  to  make  the  drug 
available  to  addicts  at  a  reasonable  cost  and  to  maintain  their  habits. 
For  many  reasons,  however,  some  of  which  Avere  political,  we  just 
couldn't  bear  to  provide  them  heroin  as  did  the  British,  so  we  came  up 
with   a   substitute   called  methadone;   is  there  any  truth  in  that 

suspicion?  .4^  Y^nr\y        .  f/ri') 

Dr.  Jaffe.  I  thnik  that  is  an  oversimplification  that  misses  many 
of  the  critical  distinctions  between  methadone  and  heroin. 

First  of  all,  the  pharmacology  of  this  drug  is  such,  as  I  pointed  out 
before,  that  you  can  get  somebody  psychologically  stabilized  and  the 
contrast  between  a  fairly  stabilized  individual  taking  an  oral  medicine 
which  has  very  few  peaks  or  valleys,  and  somebody  taking  a  drug, 
short-acting  or  intravenous,  going  up  and  down  several  times  a  day, 
is  dramatic.  People  on  this  smooth-acting  drug  can  function  iai  terms 
of  devoting  their  energies  to  productive  activity.  ;    .   .    > 

People  going  up  and  down,  taking  intravenous  doses,  really  do  not 
function  Avell.  ■<{  -t\':-> 

J  Second,  we  can  supervise  a  long-acting  eilective  oral  drug,  meaning 
that  if  we  want  tQ,  and  if  we  feel  it  absolutely  necessary,  we  can  pre- 
vent methadone  from  being  on  the  street.  Very  often,  frankly,  at  much 
too  ^reat  a  cost  to  the  rehabilitated  patient. 

Mr.  Wiggins.  I  would  like  to  know  your  views  on  how  we  can  pre- 
vent methadone  from  being  easily  available  on  the  stree^;  subject  to 
being  shotup,  cut,  sold  at  a  profit  just  like  heroin.  ^ 

Dr.  Jaffe.  Well,  No.  1,  the  dosage  form  of  methadone  could  be  so 
uniform  you  can  dissolve  it  in  fruit  juice  and  it  is  very  hard  to  extract 
,and  to  in  any  way  dilute  it  and  shoot  it. 

Mr.  Wiggins.  Say  that  again.  Is  it  difficult  to  shoot  it  ?  5 

Dr.  Jaffe.  H  you  dissolve  methadone  in  4  ounces  of  orange  juice 
and  then  try  to  concentrate  it  so  that  you  can  get  it  into  a  syringe,  you 
get  a  gummy,  sticky  mass.  There  is  nothing  you  can  do  with  it.  That  is 
the  original  way  it  was  developed,  and  many  of  the  original  programs 
went  to  great  pains  to  see  that  this  was  done. 

Second — and  I  must  say  that  as  the  volume  of  patient  j.oad  increases 
it  is  becoming  difficult  to  do  this,  and  it  may  be  a  matter  of  funding 
and  other  things — initially  every  new  patient  came  to  a  clinic  once  a 
day.  He  drank  the  methadone  under  supervision.  The  only  medicine 
on  the  street  was  in  his  belly.  There  was  no  medicine  to  sell  or  illicitly 
distribute.  Theoretically,  only  the  most  stabilized  patients  are  given 
the  privilege  of  taking  methadone  home  with  them. 

Mr.  Wiggins.  But  the  fact  is  that  methadone  is  on  the  street. 

Dr.  Jaffe.  I  can't  conceive  of  a  situation  where  you  get  uniform 
adherence  to  a  set  of  regulations,  no  matter  how  sensible  they  may  be. 
You  always  have  practitioners  who  won't  adhere  even  to  a  very  sensi- 
ble, rational  set  of  regulations;  and  you  always  have  a  very,  small 
minority  of  patients  who  are  mavericks^  who  don't  have  a  sense  of 
responsibility. 


I  have  presented  one  generic  kind  of  solution  to  this  problem.  The 
generic  solution  is  a  longer  acting  substance.  If  you  had  a  methadone 
that  only  had  to  be  given  three  times  a  week,  people  for  a  while  will 
come  three  times  a  week,  and  there  is  no  drug  on  the  street — none, 
zero. 

Now,  we  have  one  such  drug 

Mr.  Wiggins.  Excuse  me. 

I  take  it  that  a  private  physician  could  nevertheless  order  from  a 
pharmaceutical  house  a  case  of  methadone  and  dispense  it  subject  only 
to  his  personal  medical  judgment  on  the  need  for  it;  is  that  risrht? 

Dr.  Jaffe.  No  ;  I  would  say  there  is  some  vagueness  under  the  Fed- 
eral regulations.  Most  States  are  able  to  delineate  the  difference  be- 
tween treating  a  temporary  syndrome — such  as  somebody  waiting  to 
go  into  treatment,  or  treating  someone  with  a  chronic  painful  illness — 
and  maintaining  a  narcotics  user  on  methadone  with  greater  precision. 
Therefore,  a  physician  would  be  in  violation  of  State  laws  in  most 
States. 

Mr.  Wiggins.  What  controls  operate  on  a  private  physician  other 
than  his  own  judgment  in  dispensing  of  methadone  ? 

Dr.  Jaffe.  Well,  in  our  State  we  have  defined  the  chronic  treatment 
of  addiction  with  narcotic  drugs  as  not  yet  an  established  routine  medi- 
cal procedure.  So  that  in  a  sense  it  is  acceptable  as  medical  treatment 
only  in  programs  approved  by  the  department  of  mental  health.  If 
that  physician  does  not  seek  such  approval  and  adhere  to  a  protocol, 
he  may  be  subject  to  prosecution  under  our  uniform  drug  law. 

Now,  it  may  be  that  he  could  fight  that  successfully.  We  don't  know. 
But — - 

Mr.  Wiggins.  First  of  all,  is  this  a  matter  of  State  regulation? 
Dr.  Jaffe.  Yes. 

IVIr.  Wiggins.  And,  therefore,  there  may  be  50  different  sets  of  regu- 
lations in  the  country  ? 

Dr.  Jaffe.  That  might  be  the  case.  That  is  for  50  or  so. 
ISIr.  Wiggins.  Is  there  any  legal  prohibition  against  a  doctor  who  is 
so  inclined  from  purchasing  great  quantities  of  methadone? 
Dr.  Jaffe.  Not  to  the  best  of  my  knowledge. 

Mr.  Wiggins.  If  that  doctor  were  so  inclined,  what  legal  prohibitions 
preventing  him  from  dispensing  it  at  his  front  door  or  back  door  ? 

Dr.  Jaffe.  I  suppose  the  only  prohibition  would  be  his  concern  that 
a  promising  medical  career  at  which  he  earns  a  reasonable  living  could 
be  permanently  terminated  by  successful  prosecution  under  a  felony 
charge  of  illicitly  selling  narcotics. 

Mr.  AViggins.  Is  it  a  defense,  so  far  as  you  know,  to  that  charge  that 
the  doctor  believes  in  the  exercise  of  his  professional  judgment  that 
the  person  before  him  was  an  addict  and  who  would  profit  from  the  use 
of  methadone  ? 

Dr.  Jaffe.  It  would  be  a  defense,  I  suppose,  onlj'^  if  a  substantial 
number  of  his  professional  colleagues  in  that  community  stood  up 
and  said  this  is  the  good  i)ractice  of  the  community  and  it  is  in  the  best 
interests  of  tlie  patient  aiid  comnumity.  Tlie  cluinces  might  be  he 
would  be  convicted  of  a  felony. 

Mr.  Wiggins.  Given  the  situation  as  you  described  it,  are  you  satis- 
fied that  is  an  adequate  control  ? 


227 

Dr.  Jaffe.  I  think  that  more  work  has  to  be  done  in  delineating-  the 
conditions  under  which  these  drugs  can  be  used  for  the  treatment  of 

addiction.  ,.       .         p      xxtt^   •         -• 

I  am  not  satisfied  with  our  current  apphcation  ot  a  l^D,  nivesti- 

gational  drug.  .        , 

On  the  other  hand,  I  have  no  pat  solution  for  the  best  way  in  wnich 
our  health  care  delivery  system  can  become  involved  in  delivering 
the  services  to  the  advantage  of  the  patient  and  the  community. 

I  mean,  we  have  to  protect  both,  and  we  have  to  serve  both.  I  think 
more  work  has  to  be  done  on  it.  I  am  not  satisfied  with  our  present 
controls,  nor  would  I  want  to  see  us  return  to  a  purely  repressionary 
police  state  during  which  no  physician  would  ever  let  an  addict  inta 
his  office  for  fear  he  might  be  some  kind  of  local  police  informant, 
and  that  if  he  treated  him  in  any  way  he  might  be  prosecuted. 

That  was  an  era  of  sheer  terror  for  physicians,  and  the  mere  fact 
somebody  might  be  an  addict  was  sufficient  reason  for  them  to  pick  up 
the  phone  and  call  the  police  and  say  get  this  whatever-it-is  out  of  my 
office. 

Mr.  WiGGixs.  As  I  recall  it,  when  they  operated  under  a  system 
of  private  dispensing  of  heroin  the  abuses  were  so  widespread  that  the 
only  way  to  control  it  was  to  confuie  it  to  a  clinical  setting. 

Dr.  Jaffe.  Well,  I  have  no  personal  knowledge  of  what  went  on.  I 
read  the  reports.  I  know  the  details.  I  am  not  sure  that  you  w^U  get 
a  consensus  on  what  really  went  on. 

It  is  obvious  that  there  is  no  way  of  dispensing  or  prescribing  short- 
acting  drugs  without  lisking  significant  illicit  diversion.  We  have  said 
the  best  clinics  under  the  best  controls,  trying  to  dispense  heroin, 
would  open  themselves  up  to  illicit  diversion,  that  you  need  a  long- 
acting  drug  that  you  can  supervise  and  preferably  one  that  can  only 
be  used  orally.  We  have  such  pharmacological  substances  available.  It 
has  to  be  realized  that  methadone  wasn't  even  known  to  be  an  effec- 
tive narcotic  drug  until  the  late  1940's,  in  this  country. 

I  mean,  some  of  the  pharmacological  knowledge  that  we  are  talking 
about  never  existed  in  the  1920's  when  they  tried  these  clinics.  So  tliat 
one  couldn't  even  experiment  with  the  possibility  of  a  carefully  regu- 
lated controlled  system  of  treating  those  people  who  are  willing  to  be 
treated  in  this  way.  I  think  that  we  are  now  in  a  different  technologi- 
cal ball  park.  We  have  to  stop  harking  back  to  old  days,  when  we  used 
old  technology  and  look  at  what  we  can  do  now,  what  our  potentials 
are  and  what  is  the  best  way  to  strike  the  best  balance  in  treatment 
and  still,  at  the  same  time,  protect  the  community  from  widespread 
illicit  diversion  of  the  drugs  we  are  using  for  treatment. 

Chairman  Pepper.  Mr.  Brasco,  do  you  have  any  questions  ? 

Mr.  Brasco.  Yes;  I  wanted  to  ask  Dr.  Jaffe:  In  connection  with 
the  methadone  program,  would  there  be  any  great  difficulty,  given  the 
fact  that  there  is  agreement  over  the  danger  of  abusing  the  use  of 
methadone  in  the  street,  why  is  it  not  possible,  at  least  from  the  point 
of  view  of  stopping  those  who  are  in  treatment  from  proliferating 
use  in  the  street,  having  users  report  once  a  day  to  take  the  methadone 
at  the  clinic  so  we  know  we  can  stop  that  kind  of  abuse  ? 

Dr.  Jaffe.  I  think  it  is  a  fine  question.  It  has  been  raised  a  number 
of  times. 


228 

The  answer  tends  to  be  a  very  practical  one,  which  is  that  for  the 
first  3  or  4  months  you  do  insist  that  somebody  come  every  day. 
But  if  you  are  successful,  if  he  begins  to  view  himself  as  a  produc- 
tive citizen,  if  he  now  has  a  job  and  he  has  to  get  to  that  job  on  time 
and  come  back,  and  your  clinic  doesn't  happen  to  be  either  near  his 
horne  or  near  his  job,  you  are  asking  him  to  somehow  get  to  your 
clinic  once  each  day.  It  may  be  very  difficult  for  you  to  keep  the  clinic 
open  long  enough  for  him  to  get  there  every  day.  It  may  be,  for  ex- 
ample, impossible  to  get  nurses  to  work  in  certain  communities  after 
sundown. 

Mr.  Brasco.  It  becomes  a  problem  of  logistics  ? 

Dr.  Jaffe.  Primarily  a  problem  of  logistics.  It  also  becomes  a  prob- 
lem of  self-image.  We  have  had  people  in  treatment  for  3  years,  work- 
ing every  day,  earning  retirement  benefits.  They  haven't  used  any 
drugs  and  they  are  still  wondering  why  everybody  else  is  trusted  with 
phenobarbital  for  epilepsy,  and  other  people  are  trusted  with  all  kinds 
of  drugs.  ■,.,.,,, 

Mr.  Brasco.  Then  j^ou  are  saying  it  has  a  definite  effect  in  the  re- 
habilitation program  if  the  program  doesn't  give  that  basic  show  of 
trust? 

Dr.  Jaffe.  I  think  for  many  people  that  is  the  case.  But  I  am  nqt 
willing  to  push  the  logistics  aside,  because  logistics  happen  to  be  para- 
mouiit  in  a  place  lilje-I^os  Angeles,  which  has  virtually  no  public 
transportation  system.  You  are,  in  effect,  saying,  "We  want  you  to  get 
rehabilitated,  but  so  rehabilitated  you  can  have  a  .(?ar  to  get  to  the 
,  clinic  every  day." 

Chicago  has  its  own  transportation  problems,  as  every  urban  area 
does.  They  just  can't  afl^ord  to  come  to  the  clinic  every  day. 

Mr.  Brasco.  Doctor,  one  other  thing  now.   ajio  tjoy  1riIi  s/nb  snil-  n 

In  connection  with  that,  then,  and  I  don't  knowTf  you  have  .aaiy 
statistical  information  on  it,  but  wliat  is  your  experience  for  the  po- 
ten<:iality  of  abuse  of  allowing  the  methadone  to  get  out  on  the  street 
illicitly,  coming  through  those  in  treatment  ? 
; ,. ,  Dr.  Jaffe.  It  is  minimal,  butifc.is'riot  zero. 

Mr.  Brasco.  Right.  :  (^       :•  <  ,■    , 

Dr.  Jaffe.  I  want  to  emphasize  that  anybody  who  is  riealistic  knows 
that  we  are  not  treating  a  group  of  Boy  Scouts. 

Mr.  Brasco.  So  what  you  are  saying  is  it  is  a  tolerable  risk  ? 

Dr.  Jaffe.  Let's  ask  what  we  are  trading  that  risk  in  for.  Tliet's'say 
5  percent  of  people  leak  their  methadone.  Primarily  85  to  90  percent 
of  that  leaked  methadone  is  going  into  the  people  who  are  currently 
using  heroin.  l 

So,  frnidamentally,  the  methadone  will  remain  in  competition  with 
the  illicit  heroin  market  for  the  time  being,  and  that  really  doesn't 
represent  a  major  social  catastrophe  at  this  points'  yiv^.r  ■?.':(  »,7 

Mr.  Brasco.  You  said  something  before  that  was  interesting  to  me. 
You  said  that  when  they  dispense  or  when  you  dispense  methadone 
you  use  it  in — or  mixed  with — orange  juice.         r  -^iii  ^ 

Dr.  Jaffe.  Fruit  juice.  ''rnui  m  '■y<\> 

Mr.  Brasco.  And  that  it  is  most  difficult  to  conctotrate,-tilaiat  yoit  get 
a  gummy  substance ?  >  ■•■<,j.  ■■>' 

Dr.  Jaffe.  That  is  true.  ■  ^  o 


229 

Mr.  Brasco.  Then  for  those  who  are  shooting,  what  are  they  doing, 
using  the  mixture  of  the  juice  with  that  or  some  other  form  of  metha- 
done which  is  dispensed,  such  as  pills  ? 

;Dr.  Jaffe.  That  is  a  fundamental  point.  Not  everybody  is  as  con- 
cerned about  this  issue  as  we  are,  and  therefore  some  people  are  using 
different  forms  of  methadone  tablets,  methadone  diskets,  which  may, 
in  fact,  at  least  in  their  presently  constituted  form,  be  so  constructed 
that  it  is  possible  to  create  an  injectable  form  from  jt.  We  knoM'  that 
when  once  dissolved  in  fruit  juice  of  various  kinds,  it  becomes  impos- 
sible to  extract  methadone  with  ordinary  techniques. 

Mr.  Brasco.  So  then  as  a  starter,  if  we  got  to  the  point  where  metha- 
done was  only  dispensed  with  fruit  juice,  as  you  were  talking  about, 
and  I  assume  both  are  equally  effective,  then  we  would  be  taking  a  long 
step  in  the  right  direction  in  terras  of  having  abuse  of  it  reduced? 

Dr.  Jaffe.  May  I  make  one  comment?  Let  us  avoid  rigidity.  It  is 
always  the  exception  that  makes  life  difficult.  We  have  a  patient  who, 
after   Avorking   for  2  years,  wanted   to   visit   his  wife's  family  in 
Europe.  I  would  trust  him  with  my  life.  I  know  him  very  well  and  his. 
family  and  his  wife.  '^'  '  '  ' 

If  we  gave  him  21  bottles  of  juice — he  is  going  for  3  weeks — No.  1, 
it  would  spoil ;  and  No.  2,  what  do  you  think  customs  would  say  about 
these  21  bottles  of  juice  ?  You  tether  him  to  a  clinic.  There  has  to  be 
some  form  used  for  the  exceptional  case,  and  21  little  tablets  that  would 
handle  the  situation,  make  it  possible  for  him  to  function  as  a  human 
being  in  the  exceptional  situation. 

Mr.  Brasco.  Assuming  that  all  of  them  are  not  going  to  Europe,  and 
I  take  thatto  be  a  fact oini  nni  m 

Dr.  Jaffe.  That  is  true  for  the  overwhelmiilg  majority. 

Mr.  Brasco  (continuing).  So  that  we  still  would  be  taking  a  long 
step  in  the  right  direction  wdth  this  little  aside  that  you  have  in  terms 
of  possible  exceptions  cropping  up  ?  ^^''t^  -f '*  '      ^■■' '  ' 

Dr.  Jaffe.  Eight.  I  am  not  unaware  this  is  a  legislative  group.  So  I 
am  saying  I  want  to  avoid  seeing  thmgs  couched  in  such  language 
that  an  exception  automatically  becomes  a  crime,  because  as  soon  as 
you  do  that  you  really  reduce  the  possibility  of  effective  treatment. 

Mr.  Brasco.  No ;  I  wasn't  talking  about  that.  I  was  trying  to  define 
an  area  where  we  might  recommend  something. 

Dr.  Jaffe.  With  strong  recommendation  for  the  exceptional  cases 
it  would  be  very  helpful  and  would  certainly  reduce  some  of  the 
present  problems. 

Mr.  Brasco.  Just  one  last  question. 

"VVTien  you  use  methadone  intravenously,  do  you  have  the  same  expe- 
rience in  terms  of  it  becoming  a  short-lasting  kind  of  effect  as  with 
heroin  ? 

By  that  I  mean  if  you  start  to  shoot  it,  would  you  have  to  use  it 
several  times  a  day  ? 

Dr.  Jaffe.  To  the  best  of  our  knowledge.  It  is  a  little  longer  acting, 
but  you  certainly  would  have  to  use  it  several  times  a  day.  In  practice, 
people  who  use  methadone  could  use  it  several  times  a  day. 

Mr.  Brasco.  Thank  you.  I  have  nothing  else. 

Chairman  Pepper.  Mr.  Steiger. 

Mr.  Steiger.  Thank  you,  Mr.  Chairman. 


230 

I  realize  we  are  running  late. 

Doctor,  I  assume  you  have  personally  interviewed  a  good  many  of 
these  l.noo  patients. 

Dr.  Jaffjl  In  the  beginning  I  had  enough  time  to  see  a  lot  of  them 
personally.  I  must  say  as  the  program  grows  I  become  progressively 
more  insulated  from  the  direct  patient  care. 

Mr.  Steiger.  Do  you  have  any  experience  with  a  methadone  addict 
^ho  reported  into  the  program 

Dr.  J.\FFE.  Using  methadone? 

Mr.  Steiger.  Yes.  sir ;  a  man  addicted  to  methadone? 

Dr.  Jaffe.  Yes,  certainly. 

Mr.  Steiger.  "Were  you  able  to  ascertain  how  he  became  involved 
with  methadone  or  how  he  acquired  it  ? 

Dr.  Jaffe.  Well,  some  of  them  buy  it  illicitly  on  the  street.  Where 
they  get  it  is  not  clear,  but  obviously  some  people  have,  as  they  have 
for  many  years,  come  to  doctors  with  stories  of  chronic  pain,  with 
things  that  would  justify  the  prescription  of  oral  methadone'. 

Furthermore,  once  in  a  while,  before  we  had  a  program,  there  were 
physicians  who,  I  think  in  all  good  conscience,  knew  somebody  who 
was  working  and  functioning  and  the  alternatives  were  lieroin  or 
methadone.  The  physician  would  say,  "I  understand  you  are  trying 
to  get  into  a  program,''  and  for  a  few  months  he  would  prescribe  this 
medication.  He  would  call  us  up  and  say  that  this  man  was  on  metha- 
done for  several  months,  and  say,  "I  have  been  prescribing  for  him, 
this  is  the  dose,  and  the  sooner  you  take  him  into  the  program'  the 
better  off  we  will  all  feel." 

Mr.  Steiger.  Did  you  run  into  any  heroin  addicts  who  had  beeir 
acquiring  a  regular  source  of  methadone  from  a  licensed  physician, 
and  because  of  either  the  death  of  a  physician  or  his  stopping,  re- 
ported into  the  program  ? 

Dr.  Jaffe.  Oh,  that  is  not  uncommon. 

Mr.  Steiger.  I  am  not  as  concerned  as  my  colleagues  are  that  the 
responsible  clinics  are  going  to  leak  a  sufficient  volume  of  methadone 
to  create  a  new  hazard.  I  am  very  concerned  that  there  are  physicians, 
regardless  of  their  motives,  who  are  continuing  to  prescribe  methadone 
and/or  heroin.  I  wonder  from  your  experience,  again  on  the  basis 
of  interviews,  if  you  feel  there  would  be  any  merit  in  legislatively 
limiting  the  dispensing  of  methadone  and  heroin  to  licensed  clinics 
and  thereby  making  an  absolute  prohibition  against  the  private  physi- 
cian dispensing  it  ? 

Dr.  Jaffe.  Well,  first  of  all,  there  isn't  any  hei'oin  ever  dispensed 
or  prescribed.  There  is  none  in  this  country.  It  has  been  outlawed. 
There  was  a  little  bit  of  stock  in  Philadelphia  for  a  few  years  after  it 
was  outlawed,  but  there  is  none  at  the  present  time. 

I  am  generally  opposed  to  any  absolute  legal  prescription  of  some- 
thing, because  then  you  I'un  into  a  situation  where  you  ha^•e  done 
what  you  set  out  to  do,  you  have  rehabilitated  former  heroin  users  and 
they  are  offered  a  job  in  some  community  where  there  is  no  clinic. 
He  can't  accept  that  job,  and  he  can't  in  effect,  change  his  life  style 
and  start  all  over  again.. Under  appropriate  conditions,  if  there  were 
no  absolute  medical  prescriptions,  he  might  be  able  to  make  a  private 


231 

arrangement  with  tlie  physician  who  would  handle  this  problem  on  an 
individual  basis  in  a  carefully  regulated  way.^ 

Without  that  possibility  this  man  is  limited  to  any  area  that  has 
a  clinic  and  largely  these  clinics  arc  limited  to  the  large  urban  areas 
that  can  sustain  a  clinic  of  a  hundred  or  so  people. 

Mr.  Stetger.  But  isn't  it  conceivable  that  we  could  extent  the  au- 
thority to  permit  the  clinic  to  approve  the  physician  for  that  specific 
patient '? 

Dr.  Jaffe.  That  becomes  another  issue.  In  other  words,  what  you  are 
saying  is  that  no  physican  unaffiliated  with  an  approved  program 
would  be  permitted  to  prescribe  methadone  for  addicts. 

Mr.  Steiger.  Based  on  your  experience,  in  terms  of  volume  of  il- 
licit methadone,  isn't  there  a  far  greater  propensity  for  the  private 
physican  to  be  the  source  of  the  illicit  methadone  than  there  is  for 
the  clinic,  the  approved  clinic  ? 

Dr.  Jaffe.  Well,  I  think  in  terms  of  the  ratio  of  patients  treated  and 
the  amount  they  let  leak  on  the  street.  I  would  say  that  may  be  true. 
Obviously,  in  terms  of  absolute  numbers,  a  program  treating  1,600 
people  will  be  responsible  for  more  leakage  than  any  one  physician 
treating  a  few  patients. 

In  other  words,  if  he  is  only  treating  five  or  six  people, 
a  single  physician  probably  will  not  have  as  much  leakage  as  a 
j)rogram  treating  2,000. 

Mr.  Steiger.  If  those  five  or  six  people  are  dealers,  themselves  ? 

Dr.  Jaffe.  Well,  the  physician  would  have  to  be  rather  naive. 

Mr.  Steiger.  How  about  dishonest?  How  about  the  dishonest 
physician? 

Dr.  Jaffe.  Dishonest  physicians  should  be  treated  like  any  other 
dishonest  individual? 

Mr.  Steiger.  But  right  now  he  is  not  violating  anything? 

Dr.  Jaffe.  As  I  said  before,  I  think  we  have  to  think  through  our 
regulatory  procedures  so  that  the  dishonest  physician  is  treated  for 
what  he  is.  He  is  a  pusher,  operating  under  cover  of  his  medical 
license. 

Mr.  Steiger.  Eight  now,  except  for  whatever  State  regulation  may 
exist,  he  would  not  be  in  violation,  as  Mr.  Wiggins  pointed  out,  he 
could  appeal  to  his  medical  judgment  and  say  this,  in  my  best  judg- 
ment, was  what  this  particular  patient  needed,  even  if  it  obviously 
wasn't  ? 

Dr.  Jaffe.  Well,  I  certainly  think  we  have  to  think  through  how  we 
will  control  the  dishonest  physician,  there  is  no  (question  about  that. 

Mr.  Steiger.  Would  you  agree  there  is  a  question  of  the  dishonest 
physician  who  could  be  a  source  of  methadone  ? 

Dr.  Jaffe.  How  could  one  deny  it  ? 

Chairman  Pepper.  Mr.  Mann. 

Mr.  Mann.  No  questions. 

Chairman  Pepper.  Mr.  Winn. 

Mr.  Winn.  Two  quick  questions,  Mr.  Chairman. 

Doctor,  I  missed  the  first  part  of  your  testimony.  Are  any  of  your 
cases  ambulatory  when  they  come  to  you  ? 

Dr.  Jaffe.  All  of  our  cases  are  ambulatory  when  they  come  to  us. 


232 

'  ']Vir.  Winn.  Tiien  you  mentioned,  I  gatiiered,  tlios'e  that  are  now  on 
methadone? 

Dr.  Jaffe.  People  who  are  in  a  residential  setting  can  be  on  metha- 
done or  withdraw  from  methadone  in  the  same  facility.  We  have  no 
difficulty  with  that. 

Mr.  WINN.  I  missed  the  point.  I  thought  you  said  these  were  not 
people  under  hospital  care. 

Dr.  Jaffe.  No  ;  because  it  is  not  a  hospital.  It  is  a  residential  setting, 
staffed,  but  we  don't  have  round-thc-cloclt  nurses  or  elaborate  medical 
equipment.  This  is  one  way  of  reducing  the  cost.  We  don't  have,  in  a 
residential  setting  of  relatively  healthy  people,  a  little  buzzer  you  press 
and  have  three  people  running  with  an  emergency  cart. 

Mr.  Winn.  After  3  days  they  can  go  home  ? 

Dr.  Jaffe.  In  an  emergency  setting  ? 

Mr.  Winn.  Yes. 

Dr.  Jaffe.  No  ;  they  might  live  there  about  3  or  4  or  5  weeks,  trying 
to  straighten  their  lives  out. 

Mr.  Winn.  They  come  fropi  all  over  the  country,  outside  the  com- 
munity you  serve ?'  '"'''^  ®«^' ■^'"' '  ....  'T''^ 

Dr.  Jaffe.  Yes.  We  only  have  four  or  five  residential  facilities  in 
the  State. 

Mr.  Winn.  All  right.  Are  these  black  or  white,  or  both  ? 

Dr.  Jaffe.  We  have  all  integrated  facilities. 

Mr.  Winn.  Thank  youJ  ''■  ■^'  ' 

Chairman  Pepper.  Mr.  Murphy. 

Mr.  Murphy.  Doctor,  I  just  returned  from  an  around-the-world  trip 
with  Congressman  Steele  from  Connecticut,  and  the  purpose  of  the 
trip  was  to  impress  upon  these  countries  that  are  engaged  in  opium 
growing  to  curtail  their  production,  and  in  fact  eliminate  it. 

One  distressing  point  we  came  across  in  Southeast  Asia  is  that  the 
type  of  heroin  that  our  troops  are  becoming  addicted  to  is  of  a  puritj^ 
of  94-97  percent.  In  fact,  they  don't  even  have  to  mainline  it,  they  are 
snorting  it  and  thev  are  smoking  it. 

My  question  to  you.  Doctor,  is :  If  this  is  compared  to  a  6  or  7  per- 
cent purity  injection  of  the  United  States,  what  is  the  outlook  or  the 
prognosis  for  those  fellows  when  they  come  back  to  the  States.  Would 
you  just  have  to  increase  your  intensity  using  the  methadone  treatment  ? 

Dr.  Jaffe.  No;  eventually  you  can  stabilize  people  on  moderate 
doses.  The  doses  of  methadone  that  are  normally  used  for  the  heroin 
users  that  we  now  have,  Avill  be  adequate  to  handle  people  who  start 
off  using  even  pure  quantities  of  heroin.  Their  habits  aren't  that  great 
and  they  can  be  brought  down  to  a  stabilization  level  with  very  little 
difficulty. 

I  don't  anticipate  the  need  for  modifying  dosages  in  any  way,  if  one 
decides  that  is  the  best  way  to  treat  a  young  Vietnam  veteran  who  has 
never  had  any  other  treatment.  I  don't  mean  to  imply  that  would  be 
the  routine  or  immediate  response  to  finding  out  that  a  veteran  has 
used  heroin  in  Vietnam.  It  may  be  that  you  use  this  approach  only 
when  other  things  have  failed.  This  is  still  to  be  determined. 

Mr.  Murphy.  Tliank  you. 

Cliairman  Pepper.  Mr.  Sandman. 


233 

Mr.  SANDMAxlTf  ari'AcTcIi'ct  had  the  choice'b'efween  herein  aii'dmetha- 
'done — I  gather  there  isn't  any  choice — he  would  choose  heroin  ? 

Dr.  Jaffe.  Intra venbus  heroin  versus  oral  methadone  ?  I  think  most 
addicts  TTOuld  do  so :  yelsi''^'"  v,oii -. 

Mr.  Saxdmax.  From  whfft  you  say,  methadone  is  used  on  some  one 
ah-eady  addicted  to  heroin?  ' 

Dr.  Jaffe.  That  is  how  we  lise  it ;' yes. 

Mr.  Saxdiiax.  Have  you  had  any  experience  where  you  have  liad 
some  people  come  in  who  are  addicted  only  to  methadone? 

Dr.  Jaffe.  People'  wlio  ha,ve  neyer  used  any  other  drug  ?  Yes ;  a  few 
such  cases.  ia.3.^3  li^noij^y 

Mr.  Sa^'dmax.  But  they  are  rare ?  ^^  •';  ^-^;-  \/''', , 

.  Dr.  JxVFFE.  In  this  country.  They  are  not  so  rare  in' EnglkiYd' where 
people  are  beginning  to  prescribe,  methadone  tliat  can  be  used 
mtravenously.  fe^v,  ^h.oc.   odi   .n  i 

Mr.  Wixx.  Is  it  accurate  for  me  to  assume  from  your  testimony  that 
in  the  absence  of  some  other  way  or  some  other  drug  you  feel  metha- 
done is  serving  its  purpose  in  allowing  the  heroin  addict  to  at  least  be 
able  to  ciirry  but  his  responsibilities  of  life:  is  tlikt  j'bur  position? 
,  I)r.„jAFFE.  That  .is  (Sur  primary  position.  It  allows  many  of  them 
to  function,  but'  we  are  hot  prefeentilig' it  as  a  panacea.  Once  you  get 
everybody  who  can  be  effectively  treatfed  with  methadone,  treated  and 
functioning,  you  will  still  need  other  programs  for'  those  people  who 
have  not  "made  it"  with  metha;dbne  oi-  whb  are  still  not  interested  in 
methadone.  ,    ,     rf   .  j     •  .        ,  '"".',] 

.     Mr.  Wixx'tou  'm  hot' Hlaimlhg'W  is^^^ehd^  :^6s^t,:I  understand, 
^ut'in  the  absence  bf  somethiiig  better  you  feel  it'isf-  '^" :""''*" ^I''  ^'^■' 
"'  Dr.  Jaffe.  I  have  made  the  pohit  and  I  thiiik  it 'should  be  available 
to  all  those  people  who  woi;ld  like  to.give  it  a  try  and  who  qualify 
for  it.'       '  '    ''■  ''  ■'   '      '  "'■  ■  ■■    ■/'  ■;  ,,'  " 

'' Chairman  Pepper,  Mr.  Rangel.  ■Pif/Oi'- 

f .  Mr.  Raxgel.  Yes.      ^     .,l,fr.  ■    r.   a    ^  \ 

Doctor,  about  the  1,G0()  hafcotics  users,  you[py  "ifneT  ai^e- integrated, 
or  were  vou  talking  about  staff' ?    ,  ■  ■  •; 

;.,    Dr.  Jaffe.  Staff ,  too. 

^  Mr.  Raxgel.  Well,  with  the  users,  what  would  you  consider  the 
ethnic  breakdown  of  your  State's  program,  in  the  patients? 

Dr.  Jaffe.  Well,  I  haven't  looked  at  it  for  several  weeks.  It  was,  for 
the  first  couple  of  years,  about  72  percent  black.  A  small  percentage  are 
Puerto  Ricans,  Mexican  Americans,  and  the  rest  white. 

Mr.  Raxgel.  Considering  this  ethnic  breakdown  and  considering 
the  population  of  your  State,  this  sampling  reveals  an  overwhelmingly 
high  minority  breakdown.  Using  minority  as  it  is  generally  used, 
this  is  an  extremely  high  minority  figure ;  is  it  not  ? 

Dr.  Jaffe,  I  think  that  might  be  misleading.  Our  program,  as  I  said, 
be^gan  as  a  pilot  program.  We  were  going  to  diagnose  the  community. 
We  were  not  going  to  start  treating  the  entire  community  or  State, 
The  question  was:  AVhere  shall  we  put  our  initial  facilities"?  The  deci- 
sion was  made  to  locate  this  around  the  University  of  Chicago,  where 
the  University  of  Chicago  could  lend  its  iDrainpower  to  the 
development. 


60-296 — 71 — pt.  1 16 


234 

So  having  put  it  in  the  area,  having  made  our  facilities  immediately 
available  in  a  geographic  area  where  85  percent  of  the  population  is 
black,  it  is  not  surprising  that  we  had  an  overrepresentation  for  the 
program  as  a  whole.  They  had  the  most  immediate  access.  They  were 
given  first  priority  because  they  were  there. 

It  wasn't  until  a  year  and  a  half  later  that  we  had  the  first  treatment 
facility  on  the  northside  of  Chicago  where  Caucasians,  Puerto  Kicans, 
and  Mexican  Americans  could  find  it  equally  accessible. 

Mr.  Raxgel.  But  if  you  were  to  project  not  only  your  State's  but  the 
Nation's  methadone  treatment  programs,  would  not  that  same  ethnic 
breakdown  be  bound  to  exist  on  a  national  basis  ? 

Dr.  Jaffe.  It  would  be  very  hard  for  me  to  really  project  it  nation- 
ally. I  would  guess  that  in  most  of  the  large  urban  areas  of  the  East 
and  perhaps  the  Midwest  there  would  be  an  overrepresentation  of 
black  patients.  However,  in  the  Southwest  it  would  be  Mexican 
Americans. 

Mr.  Ranoel.  But  they  would  be  people  in  the  lower  economic  level 
of  American  life ;  wouldn't  they  ? 

Dr.  Jaffe.  I  think  until  very  recently  heroin  addiction  was  primar- 
ily a  problem  of  the  lower  socioeconomic  groups. 

Mr.  Rangel.  Now,  with  all  of  your  priorities  in  terms  of  where  Fed- 
eral money  should  be  spent,  I  think  you  listed  research  and  training. 
Do  you  not  think  that  perhaps  the  causes  and  the  reasons  why  a  partic- 
ular economic  group  is  prone  to  become  addicted  to  drugs  should  not 
be  one  of  the  priorities  ? 

Dr.  Jaffe.  That  was  assumed  under  research.  I  talked  about  research 
into  epidemiology,  into  what  is  responsible  for  the  epidemics,  what  is 
the  natural  history  of  these  things,  and  how  to  respond  to  these  to 
epidemics. 

Under  the  research  I  listed  those  questions  and  I  recall  saying  the 
first  priority  should  be  to  make  treatment  available  to  everybody  who 
wants  it. 

Next  we  are  to  find  out  about  why  this  happens  m  the  neighborhood 
it  happens  in  and  what  the  trends  are. 

Mr.  Rangel.  I  am  wondering.  Doctor,  if  a  different  economic  group, 
that  is,  a  more  affluent  economic  group,  were  afflicted  by  a  similar  tyj^e 
disease,  whether  or  not  we  would  be  talking  about  ma  king  methadone 
so  available  as  a  possible  cure  to  disease  or  whether  or  not  there  would 
be  a  concentration  on  research  rather  than  just  expansi<  n. 

Dr.  Jaffe.  Well,  I  can  only  tell  you  that  everyone  I  h  ave  talked  with, 
given  the  option  of  waiting  for  more  research  with  the  possibility  that 
in  the  meantime  their  children  or  relatives  might  die  of  overdoses  or 
go  to  jail,  opts  for  "Let's  take  what  we  think  is  most  eff<  ctive  and  make 
it  available." 

Mr.  Rangel.  I  don't  see  where  you  have  too  many  choices,  because 
you  have  the  problem  that  you  have  to  deal  with  and  the  best  thing 
American  research  has  come  up  with  has  been  methador  e ;  that  is  vour 
professional  opinion  ? 

Dr.  Jaffe.  Well,  for  large-scale  operation ;  yes. 

Mr.  Rangel.  But  in  terms  of  national  research,  are  you  satisfied  that 
this  Nation  is  doing  all  it  can  to  research  a  solution  to  the  drug  prob- 
lem that  we  are  having  at  the  present  time  ? 


235 

Dr.  Jaffe.  Well,  we  have  pointed  out  areas  where  more  could  be 
done.  I  think  that  lookintr  at  it  from  the  point  of  view  of  somebody 
who  has  reviewed  research  grants  and  applications  and  looked  at  the 
funding,  all  the  good  brainpower  that  wants  to  get  into  the  field,  you 
know,  is  able  to  get  involved. 

The  issue  is  getting  more  brainpower  to  bear  on  the  subject. 

Mr.  Rangel.  My  last  question  is:  Are  you  satisiied  that  the  fact 
that  the  victim  of  this  epidemic  happens  to  be  in  the  low  economic 
strata  of  our  society  has  not  affected  the  determination  of  our  Ameri- 
ca's research  in  doing  as  much  as  it  can  ?  You  don't  believe  it  would  be 
any  different  if  we  were  dealing  with  a  more  affluent  group  ? 

Dr.  Jaffe.  Well,  I  suppose  that  it  is  already  dealing  with  a  more 
affluent  group.  There  are  a  number  of  very  wealthy  suburbanites  who 
are  extremely  concerned.  But  I  think  if  you  escalate  it  into  a  crash 
program,  a  tremendous  amount  of  money  into  research  per  se,  hoping 
that  the  competent  researcher  will  materialize,  you  may  be  disap- 
pointed. You  need  to  gear  up  for  these  things  and  support  people.  I 
think  all  you  would  do  with  crash  programs  is  bring  in  a  lot  of  mar- 
ginal people. 

If  you  nave  a  phased  planning  and  say,  "Yes,  we  are  concerned  and 
at  this  stage  we  will  have  to  bring  more  people  into  it."  Then,  in  fact, 
you  have  a  program  that  will  bring  more  people  into  it. 

I  don't  think  that  research  in  this  area  is  being  underfunded,  to 
answer  your  question  more  directly,  because  the  problem  of  heroin 
addiction  affects  primarily  lower  socioeconomic  groups. 

Mr.  Ranget..  Thank  you. 

Chairman  Pepper.  We  are  running  considerably  behind  here. 

Do  you  have  any  questions?  Mr.  Brasco? 

Mr.  Brasco.  I  just  wanted  to  ask  Dr.  Jaffe — and  if  he  answered  it 
before  I  will  get  the  information  from  someone  else. 

We  were  sort  of  interrupted  when  we  were  talking  about  the  possi- 
bility of  developing  a  longer  lasting  drug,  other  than  methadone,  and 
you  said  you  didn't  want  to  promise  anything,  and  at  that  point  you 
went  to  something  else. 

Did  you  get  to  that,  because  I  was  a  few  minutes  late  and  I  am 
wondering  what  the  prognosis  is  for  developing  it. 

Dr.  Jaffe.  I  think  the  prognosis  is  excellent.  I  think  it  is  only  a 
matter  of  time  before  we  will  be  able  to  discuss  which  specific  drugs 
might  be  able  to  be  used,  and  which  would  have  significant  advantage. 

Mr.  Brasco.  Are  you  saying  we  have  them  now  ? 

Dr.  Jaffe.  Yes;  we  are  working  on  them.  We  named  one  that  is 
under  study,  that  has  been  under  study  for  a  year.  There  are  still  some 
questions  to  be  resolved  that ;  yes,  this  is  a  drug  that  can  be  used  on  a 
Avide  scale. 

Mr.  Brasco.  And  longer  lasting? 

Dr.  Jaffe.  Longer  lasting  than  methadone. 

Mr.  BPtASCo.  "Wliat  is  the  dosage  ? 

Dr.  Jaffe.  Three  times  a  week  instead  of  seven  times  a  week. 

Chairman  Pepper.  Dr.  Jaffe,  you  see  from  the  questioning  by  this 
committee  how  enormously  interested  we  are  in  your  vast  knowledge  in 
this  field.; We  are  very  grateful  for  you  coming  today  and  giving  us 
your  testimony.  I  am  sure  our  committee  would  like  to  have  the 


236 

privilege  of  continuing  to  keep  in  contact  with  you  when  we  come 
to  the  formulation  of  our  recommendations  as  to  what  more  the  Fed- 
eral Government  can  do  to  combat  heroin  addiction. 
(The  curriculum  vitae  of  Dr.  JafFe  follows:) 

[Exhibit  No.   12] 

CuRRicruLUiii;  Vitae  of  De.  Jerome  Herbert  Jaffe,  Dieector,  Illinois  Drug 

Abuse  Program  i 

Formal  education :  Temple  University;  A.B.,  psychology,  1954 ;  M.A.,  experi- 
mental psychology,  1956 ;  Temple  University  School  of  Medicine ;  M.D.,  1958. 

Awards  and  honors :  Temple  University,  College  of  Liberal  Arts ;  magna  cum 
laiide ;  distinction  in  psychology ;  alumni  prize :  highest  academic  average ;  Psi 
Chi  Award  (scholarship  and  achievement  in  psychology);  Psi  Chi,  Honorary 
Society. 

Temple  University  School  of  Medicine :  Summer  Research  Fellowship  in  Phar- 
macology, 19i57;  Babcock  Honorary  Surgical  Society:  Alpha  Omega  Alpha: 
Merck  Award :  outstanding  achievement  in  medicine  during  senior  year ;  Mosby 
Scholarship  Award  :  highest  4-year  average  in  medicine. 

Fellowships:  USPHS  Post  Doctoral  Fellowship  in  Pharmacology,  1961-1964. 
USPHS  Research  Career  Development  Award,  1964  to  1966,  1967-70.  '      ' 

^lajor  interests  :  Psychopharmacology — use  and  abuse  of  psychoactive  drugs — 
biological  and  sociological  aspects. 

Experience  and  training :  Rotating  internship — ^U.S.  Public  Health  Service 
Hospital,  Staten  Island,  N.Y.,  1958-59.  Residency  in  psychiatry— U.S.  Public 
Health  Service  Hospital,  Lexington,  Ky.,  1959-60.  Psychiatric  staff— U.S.  Pub- 
lie  Health  Service  Hospital,  Lexington,  Ky.,  1960-61.  Post  doctoral  fellow,  inter- 
disciplinary program — Albert  Einstein  College  of  Medicine,  1961-62.  Post  doc- 
toral fellow  and  resident  in  psychiatry:  Albert  Einstein  College  of  Medicine 
and  Bronx  Municipal  Hospital  Center,  1962-64.  Assistant  professor,  Departpient 
of  Pharmacology  and  Instructor,  Department  of  Psychiatry,  Albert  Einstein 
College  of  Medicine,  1964-66.  Assistant  professor.  Department  of  Psychiatry, 
University  of  Chicago,  1966-69. 

.:  Present  positions :  associate  professor,  Department  of  Psychiatry,  University 
of  Chicago,  1969  to  present.  Director,  drug  abuse  program,  Department  of 
Mental  Health,  State  of  Illinois,  1967  to  present. 

,  Memberships  in  organizations:  Alpha  Omega  Alpha,  Sigma  XI,  American 
Medical  Association.  American  Psychiatric  Association,  American  Society  of 
Pharmacology  and  Experimental  Therapeutics,  American  College  of  Neuro- 
Psychopharmacology,  New  York  Academy  of  Science,  American  Association  for 
the  Advancement  of  Science,  Illinois  Medical  Society,  Chicago  Medical  Associa- 
tion, Illinois  Psychiatric  Society,  and  World  Psychiatric  Association. 

CONSULTANTSHIPS.   ADVISORY  PANELS   AND  EDITORSHIPS 

Member,  Editorial  Board,  International  Journal  of  the  Addictions,  196&-. 

Member.  Review  Committee,  Center  for  Studies  of  Narcotics  and  Dangerous 
Drugs,  NIMH,  1966-. 

Visiting  Assistant  Professor  of  Pharmacology  and  Psychiatry,  Albert  Einstein 
College  of  Medicine,  1966-. 

Visiting  Lecturer,  University  of  Texas,  Medical  Branch,  1966-, 

Consultant,  Illinois  Narcotic  Advisory  Council,  1966-68. 

Consultant,  New  York  State  Narcotic  Addiction  Control  Commission.  1967-. 

Member,  Committee  on  Narcotics  and  Dangerous  Drugs,  Illinois  State  Medical 
Society,  1968-. 

Member,  Technical  Advisory  Board,  National  Coordinating  Council  on  Drug 
Abuse  Education  and  Information,  1969-. 

Secretary,  Section  on  Drug  Dependence,  World  Psychiatric  Association,  1969-. 

Member,  Advisory  Board,  Psychopharmacologia. 

Member,  Committee  of  the  Division  of  Clinical  Pharmacology,  American  Soci- 
ety for  Pharmacology  and  Experimental  Therapeutics,  1970-. 

Member,  Advisory  Committee.  Drug  Abuse  Training  Center,  California  State 
College,  Hayward,  California,  1970. 

Consultant,  Bureau  of  Drugs  Advisory  Panel  Systems,  Department  of  Health, 
Education  and  Welfare,  1970-. 


237 

Special  Consultant  (Technical  Adviser),  Expert  Committee  on  Drug  Depend- 
ence. World  Health  Organization,  Geneva,  Switzerland,  1970- 

Member,  American  Psychiatric  Association  Task  Force  on  Alcoholism,  1970-. 

Consultant,  Joint  Information  Service,  American  Psychiatric  Association  and 
the  National  Association  for  Mental  Health  (Project  on  Current  Methods  for  the 
Treatment  of  Addiction),  1970-. 

In  addition  to  these  on  going  advisory  and  consulting  activities,  Dr.  Jaffe 
has  been,  over  the  past  three  years,  an  invited  participant  in  more  than  fifty 
national  and  international  conferences  and  symposia.  He  has  also  served  as 
special  consultant  to  a  number  of  State  and  Local  Governments  interested  in 
developing  drug  abuse  treatment  or  educational  programs  and  has  been  the 
keynote  speaker  at  three  Governor's  Conferences.  Dr.  Jaffe  has  also  served  as  a 
consultant  to  a  number  of  temporary  State  and  Federal  advisory  panels,  as  well 
as  school  systems,  not-for-profit  corporations,  and  private  industry. 

PUBLICATIONS  OF  JEROME  HERBERT  JAFFE,   M.D. 

The  electrical  activity  of  neuronally  isolated  cortex  during  barbiturate  with- 
drawal. The  Pharmacologist,  5:250,  1963  (Abs.)    (with  S.  K.  Sharpless). 

The  rapid  development  of  physical  dependence  on  barbiturates  and  its  relation 
to  denervation  supersensitivity.  The  Pharmacologist  5:249,  1963   (Abs.)    (with 
-S.  K.  Shariiless).  ;•.•'•' 

Drug^  addiction  and  drug'  'abuse.  In,  "The  Pharmacological  Basis  of  Thera- 
peutics," 3rd  edition,  Goodman,  L.  and  Gilman,  A.  (eds.),  The  MacMillan  Co., 
-New  York,  1965. 

'     Narcotic  analgestics.  In  "The  Pharmacological  Basis  of  Therapeutics,"  3rd 
edition,  Goodman,  L.  and  Gilman,  A.  (eds.).  The  MacMillan  Co.,  New  York,  1965. 

The  rapid  development  of  physical  dependence  on  barbiturates,  (with  S.  K. 
Sharpless)  /.  Pharmacol,  and  Exper.  Ther.,  150 :140-145, 1965. 

Changes  in  CNS  sensitivity  to  cholinergic  (muscarinic)  agonists  following 
withdrawal  of  chronically  administered  scopolamine.  The  Pharmacologist  8 :199, 
1966  (Abs.)    (with  M.  J.  Friedman). 

The  electrical  excitability  of  isolated  cortex  during  barbiturate  withdrawal, 
(with  S.  K.  Sharpless)  J.  Pharmacol,  and  Uxper.  Ther.  151 :321-329,  1966. 

Research  on  newer  methods  of  treatment  of  drug  dependent  individuals  in 
the  U.S.A.  Proceedings  of  the  Fifth  International  Congress  of  the  Collegium 
International  Neuropsychopharmacologicum,  Washington,  D.C.,  Excerpta  Medica 
Intern ational  Congress  Series,  129  :271-276,  1966. 

Cyclazocine,  a  long  acting  narcotic  antagonist :  its  voluntary  acceptance  as  a 
treatment  modality  by  ambulatory  narcotics  users.  Xwith  L.  Brill)  Internat.  J. 
Addictions,  1 :99-123,  1966.  o-'-'^i' 

The  use  of  ion-exchange  resin  impregnated  paper  in  the  detection  of  opiate 
alkaloids,  amphetamines,  phenothiazines  and  barbiturates  is  urine,  (with  Dahlia 
Kirkpatrick)  Psychopharm.  Bull.,  S  :,  No.  4,  49-52, 1966.  ■ 

The  relevancy  of  some  newer  American  treatment  approaches  for  England, 
Brit.  J.  Addict.,  62  :375-386,  1967  (with  L.  Brill).  .       . 

Cyclazocine  in  the  treatment  of  narcotics  addiction.  In.  "Current  Psychiatric 
Therapies,"  Masserman,  J.  (ed.),  Grune  and  Stratton,  New  York,  1967. 

Pharmalogical  denervation  supersensitivity  in  the  CNS :  A  theory  of  physical 
dependence,  (with  S.  K.  Sharpless)  In,  "The  Addictive  States",  Wikler,  A.  (ed.), 
The  V\'illiams  and  Wilkins  Co.,  Baltimore,  1968. 

Narcotics  in  the  treatment  of  pain,  Med.  OUn.  North  Am,.,  52  :33-45,  1968. 

Drug  addiction :  New  approaches  to  an  old  problem.  Postgrad.  Med.,  45 :73-81, 
1968  (with  J.  Skom  and  J.  Hastings). 

Opiate  dependence  and  the  use  of  narcotics  for  the  relief  of  pain.  In,  "Modern 
Treatment",  Wang,  R.  (ed.),  5 :1121-1135, 1968.  ^ 

Psychopharmacology  and  opiate  dependence.  In,  " Psych opharmacology :  A  re- 
view of  Progress,  1957-1967,"  Efron,  D.  H.,  Cole,  J.  O.,  Levine,  J.,  Wittenborn, 
J.  R.  (eds.).  Proceedings  of  the  Sixth  Annual  Meeting  of  the  American  College 
of  Neurophyschopharmacology,  San  Juan,  Puerto  Rico,  December,  1967. 

Cannabis  (marihuana).  In  "Encyclopedia  Americana,"  Grolier,  N.Y.,  1969. 

Drug  addiction  and  drug  abuse.  In,  "Encyclopedia  Americana,"  Grolier,  N.Y.. 
1969. 

A  review  of  the  approaches  to  the  problem  of  compulsive  narcotics  use.  In, 
"Drugs  and  Youth",  Wittenborn,  J.  R. ;  Brill,  H. ;  Smith,  J.  P. ;  and  Wittenborn,  S, 
(eds.),  Charles  C.  Thomas,  Springfield,  1969. 


238 

A  central  hypothermic  response  to  pilocarpine  in  the  mouse.  J.  Pharmacol,  exp. 
T/ier.,  167:34-44, 1969  (with  M.J.  Friedman  (1)). 

Central  nervous  system  supersensitivity  to  pilocarpine  after  withdrawal  of 
chronically  administered  scopolamine.  J.  Pharmacol,  exp.  ther.,  167:45-55,  1969 
(with  M.  J.  Friedman  (1)  and  S.  K.  Sharpless).  . 

Pharmacological  approaches  to  the  treatment  of  compulsive  opiate  use :  iheir 
rationale  and  current  status.  In,  "Drugs  and  the  Brain,"  Black,  P.  (ed),  Balti- 
more, 1969.  ^  ,.^  ^      ^u 

Experience  with  the  use  of  methadone  in  a  multi-modality  program  for  the 
treatment  of  narcotics  users.  Internat.  J.  Addictions,  4  (3),  481-i90,  1969  (with 
M.  Zaks  and  E.  Washington). 

Problems  in  Drug  Abuse  Education  :  Two  Hypotheses.  In,  "Communication  and 
Drug  Abuse:  (with  D.  Deitch)."  Proceedings  of  the  Second  Rutgers  Symposium 
on  Drug  Abuse,  Rutgers  University,  New  Brunswick,  New  Jersey,  1969. 

Tetrahydrocannabinol:  neurochemical  and  behavioral  effects  in  the  mouse. 
Science,  163,  1464-1467,  New  York,  1969.  (with  Holtzman,  D.  (1)  Lovell,  R.  A., 
and  Freedman,  D.  X.). 

The  treatment  of  drug  abusers.  In,  "Principles  of  Psychipharmacology",  Clark, 
W.,  and  del  Guidice,  J.  (eds. ) ,  Academic  Press,  New  York,  1970. 

Whatever  Turns  You  Off.  Psychology  Today,  3,  (12),  42^4, 1970. 

A  comparison  of  dl-alpha-acetylmethadol  and  methadone  in  the  treatment  of 
chronic  heroin  users:  a  pilot  study.  JAMA,  211  (11),  1834-1836,  1970  (with  C.  R. 
Schuster,  B.  Smith,  and  P.  Blachly). 

The  implementation  and  evaluation  of  new  treatments  for  compulsive  drug 
users.  In,  "Advances  in  Mental  Science  II — Drug  Dependence"  Harris,  R.  T. ; 
Mclsaac.  W.  M. ;  and  Schuster,  Jr.,  C.  R.  (eds.).  University  of  Texas  Press, 
Austin,  1970. 

Narcotic  Analgesics.  In,  "The  Pharmacological  Basis  of  Therapeutics",  4th 
Edition,  Chapter  15,  Goodman,  L.  and  Gilman,  A.  (eds.).  The  MacMillan  Com- 
pany, New  York,  1970. 

Drug  Addiction  and  Drug  Abuse.  In,  "The  Pharmacological  Basis  of  Thera- 
peutics", 4th  Edition,  Chapter  16,  Goodman,  L.,  and  Gilman,  A.  (eds.).  The  Mac- 
Millan Company,  New  York,  1970. 

Further  experience  with  the  use  of  methadone.  International  Journal  of  the 
Addictions,  September  1970. 

Development  of  a  successful  treatment  program  for  narcotics  addicts  in  Illinois. 
Chapter  3,  In,  "Proceedings  of  the  Second  Western  Institute  on  Problems  of  Drug 
Dependence",  Blachly,  P.  (ed.). 

Drug  maintenance  and  antagonists :  limits  and  possibilities.  Proceedings  of  the 
November  24,  1969  Conference  of  the  New  York  State  Narcotic  Addiction  Control 
Commission. 

An  identification  of  techniques  for  the  large  scale  detection  of  Narcotics,  bar- 
biturates, and  central  nervous  system  stimulants  in  a  urine  monitoring  program. 
In  Abstracts  of  the  Academy  of  Pharmaceutical  Sciences,  (117)  with  K.  K. 
Kaistha. 

An  overview  of  the  conference.  Proceedings  of  a  Conference  on  Methodology  on 
the  Prediction  of  Drug  Abuse  Potential,  Washington,  D.C.,  September  8-10,  1969. 
U.S.  Government  Printing  OflBce. 

In  press 

The  heroin  copping  area :  a  location  for  epidemiological  study  and  interven- 
tion activity.  Archives  of  General  Psychiatry ,  (with  Pat  Hughes). 

Developing  in-patient  services  for  community  based  treatment  of  narcotic 
addiction.  Archives  of  General  Psychiatry,  (with  Hughes,  P.,  Chappel,  J., 
Senay,  E.). 

Methadone  and  1-Methadyl  Acetate  in  the  management  of  narcotics  addicts. 
JAMA,  (with  E.  C.  Senay). 

Effects  of  variation  of  methadone  dose  on  the  outcome  of  treatment  of  heroin 
tisers,  Proceedings  of  the  Annual  Scientific  meeting  of  the  Committee  on  the 
Problems  of  Drug  Dependence.  February  16.  1071.    (with  S.  DiMonza). 

Experience  with  eyolnzocine  in  a  nuilti-modality  treatment  prosram  for  nnr- 
cotics  addicts.  International  Journal  of  the  Addictions,  (with  J.  N.  CbappeU 
E.  C.  Senay). 


239 

Submitted  or  accepted  for  publication 

Role  of  hospitalization  in  tlie  treatment  of  drug  addiction,  (with  J.  N. 
Chappel). 

A  double-blind  controlled  study  of  cyclazocine  in  the  treatment  of  heroin 
users,  (with  J.  N.  Chappel). 

Extraction  and  identification  techniques  for  drugs  of  abuse  in  a  urine  screen- 
ing program.  Presented  to  the  Annual  Scientific  Meeting  of  the  Committee  on 
Problems  of  Drug  Dependence,  Toronto,  February  16, 1971,  (with  K.  K.  Kaistha). 

In  preparation 

Successful  withdrawal  from  methadone :  a  1-year  follow-up. 

Minimal  methadone  support  for  narcotics  addicts  awaiting  entry  into  a  com- 
prehensive addiction  rehabilitation  program. 

(A  brief  recess  was  taken. ) 

Chainnan  Pepper.  The  committee  will  come  to  order,  please. 

Our  next  witness  is  Dr.  Harvey  Gollance,  assistant  director,  Beth 
Israel  Medical  Center  in  New  York  City,  with  specific  responsibility 
for  the  center's  narcotic  programs. 

Before  assuming  his  present  position,  Dr.  Gollance  was  deputy 
commissioner  for  operations  of  the  New  York  City  Department  of 
Hospitals,  in  which  post  he  was  in  charge  of  operations  at  19  munici- 
pal hospitals. 

He  has  also  served  as  supervising  medical  superintendent  of  Kings 
County  Hospital  Center. 

Dr.  Gollance  is  a  fellow  of  the  American  College  of  Hospital  Admin- 
istrators and  the  American  Public  Health  Association. 

Dr.  Gollance  has  had  extensive  experience  in  narcotics  treatment 
programs,  and  is  a  member  of  the  narcotics  register  advisory  commit- 
tee of  the  New  York  City  Department  of  Health  and  the  methadone 
evaluation  committee  of  the  Columbia  University  School  of  Public 
Health  and  Administrative  Medicine. 

Dr.  Gollance,  we  are  grateful  for  your  appearance  here  today. 

Mr.  Perito,  will  you  inquire  ? 

Mr.  Perito.  Dr.  Gollance,  I  understand  you  have  a  statement  which 
you  are  going  to  offer  for  the  record  and  briefly  summarize. 

STATEMENT  OF  DR.  HARVEY  GOLLANCE,  ASSOCIATE  DIRECTOR, 
BETH  ISRAEL  MEDICAL  CENTER,  NEW  YORK,  N.Y. 

Dr.  Gollance.  I  would  like  to  make  a  brief  statement. 

I  know  you  have  heard  a  lot  about  methadone.  We  run  the  largest 
methadone  program  in  the  world.  We  are  pioneers  in  this.  The  Beth 
Israel  Medical  Center  is  the  largest  voluntary  hospital  for  the  treat- 
ment of  narcotics  addiction  in  the  world.  We  have  350  beds  for  nar- 
cotic addiction  treatment.  We  admit  over  9,000  patients  to  our  detoxi- 
fication service,  and  over  3.200  patients  are  under  active  treatment  in 
our  methadone  maintenance  program. 

We  sponsor  this  program  in  12  other  hospitals  in  New  York  City, 
some  of  the  most  outstanding  hospitals  in  the  world. 

I  would  like  to  start  with  a  brief  statement  of  how  the  methadone 
treatment  program  came  into  being,  because  I  think  this  is  important. 

We  have  had  very  serious  heroin  addiction  in  New  York  City  for 
over  20  years.  It  struck  in  the  low-income  areas  of  the  city,  Harlem, 


240 

South  Bronx,  Bedford-Stuyvesant,  and  it  was  different  from  any 
addiction  problem  we  had  had  before.  Formerly  addiction  was  some- 
thing among  doctors,  nurses,  people  of  some  means. 

In  the  early  1950's  a  demand  arose  that  the  city  do  something  about 
it  because  they  had  practically  no  facilities  for  the  treatment  of  drug 
addiction. 

In  response  to  this  demand,  the  city  did  several  things.  It  opened 
a  hospital  for  drug  users  called  Riverside  Hospital  and  in  its  early 
years  an  earnest  attempt  was  made  with  psychologists,  psychiatrists, 
social  workers,  et  cetera.  The  board  of  education  opened  a  school  and 
supplied  an  interested  faculty.  irOM*^ 

Riverside  Hospital  was  opened  in  1953.  : 

In  1958,  the  health  commissioner  of  the  State  of  New  York  wanted 
to  see  what  the  State  was  getting  for  its  money,  and  he  had  the  Colum- 
bia University  School  of  Public  Health  do  a  survey  of  the  patients 
who  had  been  in  Riverside  Hospital,  and  they  took  a  certain  time 
period  and  then  tracked  down  the  cases  treated  in  that  period,  1955, 

What  this  study  found  was  an  unusually  high  death  ra-te ;  but  of 
those  who  survived,  none  were  off  heroin.  It  was  obvious  Riverside 
Hospital  was  a  failure  as  far  as  getting  anybody  free  of  heroin.  It 
did  give  some  social  first  {lid,  a  chance  to  reduce  dope  and  stay  away 
from  the  police.  It  is  obvious  there  was  no  single  treatment  allowed  for 
hard-core  heroin  addiction,  , ,        r  'l,  'iroll-yt  Si  ^r  /^•ji-pilU  •-  >  .iii 

In  1963,  the  health  research  council  of  New  York  City  got  Dr, 
Vincent  Dole,  later  joined  by  Dr,  Nyswander,  to  do  research  in  the 
treatment  of  drug  addiction;  Dr.  Dole  went  on  the  assumption  that 
whatever  the  psychological  or  sociological  reasons  that  a  person  be- 
came addicted,  once  he  was  thoroughly  addicted  there  was  a  physio- 
logical change  and  unless  he  did  something  about  this  he  would  not  b^ 
able  to  rehabilitate  the  patient,  the  hard-core  heroin  addict,  .  .( ; 

Dr.  Dole's  goal  was  rehabilitation.  By  that  he  meant  the  addict 
could  function  in  our  society  as  well  as  he  was  capable. 

Dr.  Dole  tried  several  things.  He  tried  to  see  if  he  could  stabilize 
a  patient  on  morphine,  some  other  narcotics.  It  didn't  work.  Then 
he  used  methadone  in  a  new  way.  It  is  a  synthetic  narcotic  that  was 
used  in  World  War  II  by  the  Germans,  when  their  supply  of  opium 
was  cut  off. 

After  the  war  methadone  was  used  mostly  for  the  detoxification 
of  patients — to  get  them  drug  free  in  a  humane  way  instead  of  suffer- 
ing throuerh  "cold  turkey."  In  a  week  you  can  get  any  heroin  addict  off 
heroin.  The  point  is  the  addict  won't  stay  off  heroin.  Dr.  Dole  wanted 
to  see  what  would  happen  if  instead  of  reducing  the  dose  of  methadone 
as  in  detoxification,  he  gradually  increased  the  dose.  He  foimd  two 
things :  Wlien  a  certain  level  was  reached  the  addict  lost  his  drug  hun- 
ger. He  no  longer  had  any  craving  for  heroin,  and  if  you  went  to  a 
still  higher  dose  it  blocked  the  effect  of  heroin. 

Dr.  Dole  got  pure  heroin  and  .eventually  injected  Inr.o-e  quantities 
of  heroin  into  patients  on  blocking  doses  of  methadone.  Xothiiig  hap- 
pened. This  is  called  the  blocking  effect. 

When  we  speak  of  the  methadone  maintenance  treatment  program 
we  mean  the  Dole-Nyswander  technique  of  givmg  blocking  doses  of 
methadone — not  just  giving  methadone  in  any  haphazard  sort  of  way. 


MS 

■  Methadone  has  properties  that  make  it  very  useful  for  this  woik.  It 
is  fully  effective  by  mouth,  it  is  long  acting;  once  you  get  a  patient 
stabilized,  a  single  dose  by  mouth  will  last  him  24-36  hours.  It  is  a 
safe  drug.        .a^j'-r  ;->,>■. . 

We  haven't  had  any  serious  harmf ill' effects  either  medically,  sur- 
gically, or  obstetrically  in  7  years.  The  body  develops  great  tolerance 
for  methadone  in  a  relatively  short  tima  It  no  longer  acts  as  a  nar- 
cotic. By  that  I  mean  it  does  not  make  the  patient  high  and  it  doesn't 
make  him  sleepy.  It  is,  however,  addictive.  If  taken  away  from  the 
patient  he  would  have  withdrawal  symptoms.         '•  '  ■ 

Dr.  Dole  did  this  work  with  six  cases  at  Rockefeller  Institute  and 
then  came  to  Dr.  Ray  Trussell,  who  was  then  commissioner  of  hospitals 
in  New  York  City,  and  asked  for  facilities  to  expand  his  work. 

Through  Dr.  Trussell 's  efforts,  Dr.  Dole  got  the  beds  in  what  is  now 
the  Beth  Israel  Medical  Unit  for  Drug  Addiction.  We  inaugurated 
this  program  in  1965. 

When  Dr.  Trussell  set  this  program  up,  he  insisted  that  a  separate 
contract  be  given  to  the  Columbia  University  School  of  Public  Health 
to  do  an  independent  evaluation  of  what  happened  to  every  patient  in 
the  methadone  program.  This  is  important.  We  now  have  records  of 
every  single  patient  who  has  ever  come  into  our  program,  and  these 
results  have  been  independently  evaluated  by  the  Columbia  University 
School  of  Public  Health.     .i^i"bji  bsmiiiuor)  a  >.i  nn-nU] 

If  we  are  going  to  get  ahywh'er^'in  treafm'g  driig  addiction  we  must 
know  what  works  and  what  doesn't  work.  T  think  this  independent 
evaluation  is  an  important  part  of  this  program.  ,»it/.)!^' 

-  Originally  the  patient  was  taken  into  the  hospital  for  6  weeks.  After 
he  was  stabilized,  he  was  sent  to  a  clinic  with  a  number  of  supporting 
services :  counselors,  research  assistants,  social  workers.  The  goal  is  re- 
habilitation, not  just  to  satisfy  the  drug  hunger.  .ip/iwrr:, 
J  Many  of  our  patients  started-  very  young.  You  now  have  help  for 
them  with  all  their  problems,  help  them  with  welfare,  with  the  courts, 
with  their  wives,  get  a  job,  all  of  these  things.  -You  must  help  to  get 
the  patient  intothe  square  society f'  if^^"'  '^fut.'/  '.v^jiyrf  o1  ojJIi  [t 

We  do  this.  We  believe  that  a  methadone  hlaiTitenarice  program 
should  be  done  in  a  structured  program.  You  must  know  whtit  hap- 
pens to  your  patient,  and  you  work  intimately  with  him.  ■ 
_  As  a  matter  of  fact,  we  don't  let  an  individual  clinic  exceed  150  pa- 
tients. We  want  the  staff  to  know  the  patient  well  and  what  is  happen- 
ing to  him.  At  the  present  time  we  have  almost  40  clinics  scattered 
throughout  the  New  York  City  area.                ;  .             ".i 

When  we  reach  a  census  of  150,  we  open  a  new' clinic.  Wedobkat 
the  addict  as  an  individual  with  a  chronic  illness.  He  is  a  m.edical  pa- 
tient. We  base  our  program  on  a  hospital.  IMost  all  our  clinics  are  out  in 
the  community.  They  are  considered  an  extension  of  the  hospital.  We 
think  this  philosophy  of  medical  en  re  is  important. 

Addicts  have  other  problems  besides  their  addiction.  They  have 
medical  problems.  The  medical  profession  has  shunned  treatment  of 
drug  addiction  for  a  number  of  generations  now.  In  the  past  it  was 
too  dangerous  for  a  doctor  to  deal  with  drug  addicts.  He  risked  prose- 
cution and  possible  jail. 

We  now  have  a  medically  based  program  with  a  hospital  to  take 


242 

€are  of  patient  addicts.  We  have  seen  some  very  interesting  byprod- 
ucts of  this  other  than  the  direct  treatment  of  addiction.  We  find  out 
that  when  we  set  up  a  clinic  associated  with  a  hospital,  the  medical 
staffs  become  interested  in  treatment  of  drug  addiction.  If  we  are  go- 
ing to  get  anywhere  in  this  field  we  need  to  bring  the  best  brains  we 
have  into  solving  this  difficult  problem.  Methadone  maintenance  has 
set  up  a  climate  favorable  for  this. 

Methadone  is  not  the  final  answer.  It  happens  to  be  the  best  answer 
we  have  at  this  time  for  treatment  of  the  hard-core  heroin  addict. 

Dr.  Dole's  original  criteria  were  that  the  patients  had  to  be  21  years 
of  age  and  under  40,  because  there  is  a  theory  around  that  drug  addic- 
tion burns  itself  out  as  the  patient  gets  older. 

They  had  to  have  a  history  of  mainlining  heroin.  They  were  hard- 
core addicts.  They  all  had  criminal  records  and  had  tried  other  pro- 
grams without  success,  to  further  confirm  their  serious  addiction. 

The  original  program,  because  it  was  new,  excluded  certain  condi- 
tions: alcoholism,  pregnancy,  mixed  drug  use.  However,  as  we  have 
gained  much  experience  we  have  broadened  the  criteria  for  admission. 
We  admit  now  a  patient  over  the  age  of  18,  there  is  no  longer  an  upper 
age  limit.  We  have  one  man  87,  one  82,  and  a  number  collecting  social 
security. 

We  now  require  2  years  of  heroin  addiction.  We  are  very  careful  to 
see  that  the  applicant  is  a  confirmed  addict. 

This  is  a  voluntary  program.  In  our  experience  it  takes  about  2 
years  before  a  heroin  addict  is  first  willing  to  do  something  about  his 
addiction.  At  the  beginning  the  drug  addict  rather  enjoys  the  high 
he  gets.  He  is  a  very  busy  individual  supporting  his  habit  by  stealing. 
He  rather  enjoys  that  culture  at  the  beginning.  We  feel  it  takes  2  years 
before  he  is  willing  to  do  something  constructive  by  entering  this 
program. 

For  this  group  of  cases,  this  program  has  proved  very  successful.  I 
believe  you  heard  Dr.  Gearing.  She  does  our  evaluation.  She  is  a  very 
competent  individual. 

I  would  like  to  review  what  our  experience  has  been.  Basically  we 
liave  an  80-percent  retention  rate  in  the  program.  We  have  a  20-per- 
cent dropout  rate.  Very  few  of  the  patients  drop  out  of  their  own  voli- 
tion. They  are  usually  dropped  out  by  us  for  administrative  reasons. 
These  turn  out  to  be  severe  alcoholics,  a  few  get  arrested  early  in  the 
program  or  use  other  drugs. 

The  work  records  are  very  interesting.  I  don't  have  the  most  recent 
figures.  I  don't  know  what  ejffect  the  present  recession  will  have.  Up  to 
about  a  year  or  two  ago  our  patients  were  about  25  percent  legit- 
imately employed  when  they  started.  At  the  end  of  6  months,  about  50 
percent  are  working  and  after  2  years  80  percent.  For  those  in  the 
jDrogram  3  years  or  longer,  92  percent  were  either  working,  keeping 
house,  or  going  to  school,  and  only  6  percent  were  left  on  welfare. 

Tlie  arrest  records  in  our  program  have  been  phenomenal.  Dr.  Gear- 
ing did  a  study  of  arrest  patterns.  She  took  a  group  before  they  came 
into  the  methadone  program  and  studied  their  arrest  records.  It  showed 
115  arrests  per  100  patients  in  the  course  of  a  year,  48  convictions  per 
100  patients  in  the  course  of  a  year.  She  then  followed  the  course  of 
these  patients  for  4  years  after  they  started  on  methadone. 


2fi3 

The  115  arrests  per  100  per  year  dropped  to  4.5.  The  48  convictions 
dropped  to  1  per  100  per  year.  The  arrests  practically  disappear  and 
the  longer  in  the  program,  the  fewer  the  arrests. 

Here  was  a  program  that  took  hard-core  heroin  addicts  whose  treat- 
ment had  been  very  unsuccessful  before.  I,  myself,  when  I  was  deputy 
commissioner  of  hospitals,  tried  setting  up  programs,  pleading  with 
doctors  to  set  up  programs.  I  was  not  successful.  The  few  programs  in 
existence  were  very  unsuccessful  and  most  physicians  I  knew  were 
very  discouraged. 

Now,  we  take  a  large  number  of  severe  heroin  addicts  and  you  have 
them  working,  you  keep  them  out  of  jail,  you  put  tlieir  families  to- 
gether. 

That  doesn't  mean  we  have  all  angels  in  our  programs.  "We  have 
some  who  have  problems.  Some  will  do  things  they  shouldn't,  but  on 
the  whole  this  has  been  a  very  successful  program. 
With  that  introduction,  I  would  like  to  answer  some  questions. 
Chairman  Pepper.  That  is  a  very  good  summary. 
Dr.  GoLLANCE.  Could  I  answer  the  previous  question  about  dispens- 
ing it  ? 

I  would  be  against  dispensing  it  just  in  pills.  We  have  changed  over 
to  what  we  call  a  disket.  It  is  a  large  tablet  that  leaves  a  sludge,  and 
the  patients  can't  inject  it.  We  use  diskets  to  prevent  careless  handling 
so  that  children  can't  get  them. 

For  this  reason  we  have  a  tendency  to  use  diskets  dispensed  in  vials 

with  locking  caps  where  they  can  be  kept  in  the  medicine  chest  away 

from  children. 

Mr.  Brasco.  That  is  the  question  I  asked.  Doctor. 

Do  you  agree  with  Dr.  Jaffe,  then,  of  the  impracticality  in  New 

York  of  having  a  patient  come  once  a  day  for  his  dosage  rather 

than 

Dr.  GoLLANCE.  Yes;  when  you  are  on  a  very  large  scale  program. 
Mr.  Brasco.  So  you  agree  ? 

Dr.  Gollance.  Yes ;  and  for  the  reason  Dr.  Jaffe  said,  we  are  trying^ 
to  rehabilitate  patients. 

Mr.  Brasco.  The  disket  is  something  that  cannot  be  injected;  is 
that  correct  ? 

Dr.  Gollance.  That  is  correct. 

Mr.  Brasco.  I  was  concerned  about  working  with  substances  that 
would  be  practical  for  carrying  and  used  just  as  long  as  they  could 
not  be  used  intravenously. 
Dr.  Gollance.  That  is  right. 

Mr.  Brasco.  But  that  disket  is  not  something  capable  of  being  used 
intravenously  ? 

Dr.  Gollance.  That  is  correct.  I  would  like  to  answer  Congressman 
R angel  on  the  ethnic  distribution  of  patients  in  New  York.  We  have 
a  narcotic  registry  run  by  the  health  department  and  the  ethnic  dis- 
tribution of  their  list  is  50  percent  black,  25  percent  white,  25  percent 
Puerto  Rican. 

The  patients  in  our  programs  approximate  that  ethnic  distribution. 
I  would  also  like  to  say  that  this  is  no  longer  a  situation  of  the  low- 
income  group.  Last  week  the  daughter  of  a  prominent  professor  and 
the  son-in-law  of  a  prominent  head  of  surgery  in  one  of  the  leading 


244 

hospitals  in  the  city,  came  into  our  program.  In  answer  to  your  ques- 
tion, two  marines  I  know  personally  came  back  addicted.  The  reason 
the  marines  snort  heroin  and  don't  inject  it  is  so  they  won't  leave 
trackmarks.  But  when  they  come  back  here  they  will  start  injecting 
heroin.  This  one  Marine  had  gotten  $6,000  from  an  automobile  acci- 
dent and  wanted  to  return  to  the  Orient  for  drugs.  I  got  him  into  the 
methadone  program  and  he  is  doing  very  well,  u;  ruoiu  i 

Chairman  Pepper.  Mr.  Perito,  please  proceed. 

Mr.  Perito.  Thank  you,  Mr.  Chairman. 

First,  Doctor,  do  you  believe  that  private  physicians  should  be  per- 
mitted to  maintain  addicts  on  a  maintenance  program  ? 

Dr.  GoLLAxcE.  At  this  time  I  would  say  no.  Our  feeling  is  that  this 
should  be  done  in  a  structured  program.  We  have  given  a  lot  of 
thought  to  how  to  use  private  practitioners.  For  example,  if  we  had  a 
well-stabilized  patient  he  might  be  referred  to  a  private  practitioner. 
If  this  were  done,  it  would  furnish  a  means  of  having  the  patient 
checked,  because  there  is  possibility  of  abuse. 

There  is  the  program  in  New  York  City  that  disburses 

Mr.  Pertto.  You  mean  dispensing  of  methadone  by  a  private  physi- 
cian ;  is  that  what  you  are  talking  about  ? 

Dr.  Gollance.  That  is  right. 

Mr.  Perito.  What  steps  can  be  taken  in  order  to  avoid  problems 
of  this  nature ?     ,  "' '  ^'''^  ^'^^^-'^ ^^''^ ■' '^ ' f^'^  ^ '•! i J  o^ 

Dr.  Gollance.  Well,  the  thing  is  if  you  can  set  up  enough  programs 
so  the  patient  can  come  in  and  get  it  from  established  programs  very 
cheaply  and  receive  good  care.  We  g&t  many  patients  from  this  private 
doctor  when  we  can  reach  him  on  our  list.  '^-^  ''^-  ' "'''  ^  ■o.iPj.i,:>.  i  .^i/: 

Unfortunately,  we  have  quite  a  long  waiting  list.  The  last  time  T  was 
before  this  committee,  we  were  asked  how  can  we  expand  the  program. 
I  might  say,  since  that  time  last  year,  we  have  taken  as  many  patients 
in  1  year  as  were  taken  in  all  of  the  previous  5  years.  We  have  the 
mechanism  for  expanding  this  widely  if' we  get  the  necessary  funds 

Mr.  Perito.  Do  you  believe  addiction  is  a  metabolic  situation  ? 

Dr.  Gollance.  I  think  you  have  to  make  that  assumption.  At  least 
it  has  worked  here.  The  psychological  and  sociological  apiproaches 
have  not  worked  for  this  type  of  patient.  We  have  tried  all  these 
things  without  methadone  and  they  haven't  worked.  Under  methadone 
you  can  use  a  number  of  successful  aLppjcoac.hes,  but  without  it  we  have 
been  very  unsuccessful.  'c.  ..,.     ^.i.  _ii; 

Mr.  Perito.  What  steps  have  you  taken  in  your  program  to  control 
diversion? 

Dr.  Gollance.  First  of  all,  we  limit  the  size  of  the  clinic  so  we 
know  the  patient.  We  constantly  watch  the  patient,  besides  the  urine 
checks,  to  know  that  he  is  not  using  Other  drugs,  and  if  we  have  any 
suspicion  at  all  we  will  put  him  on  a  daily  regime. 

One  of  the  interesting  tilings  is  the  patient  develops  a  loyalty  to  tlie 
program.  I  know  addicts  are  not  supposed  to  squeal,  biit  tliey  will 
come  to  us  and  toll  us.  look  out  for  this  f'^How.  and  avo  will.  Thoy  will 
give  us  information  about  our  patients.  We  have  a  patient-phvsician 
relationship.  We  don't  take  a  punitive  approach.  We  don't  look  at  the 
addict  as  a  dope  fiend  or  outcast.  We  encourage  him  to  tell  us  when 
he  is  abusinc:.  In  the  first  few  weeks  he  will. 


245 

If  he  is  using  other  drugs  we  will  ask  him  to  tell  us  so  we  can  work 
with  him. 

Mr.  Perito.  Finally,  Doctor,  to  the  best  of  your  knowledge,  is  there 
a  black  market  for  and  in  methadone  in  New  York  City? 

Dr.  GoLLANCE.  I  am  sorry  to  say  there  is.  We  have  asked  the  police 
repeatedly,  ever  since  we  have  had  the  program,  do  they  thuik  our 
program  is  a  problem  for  them. 

Tliey  have  told  us  our  program  is  not.  But  we  do  know  it  is  getting 
on  the*^  streets  from  some  very  unstructured,  unsupervised  programs. 

I  appeared  before  a  group  of  probation  officers  and  a  police  officer, 
and  he  said,  "I  know  it  gets  on  the  street."  I  said,  "I  would  like  to  see 
it.  I  don't  think  it  is  any  of  ours."  He  pulled  out  a  vial  and  there  was 
a  label  of  this  unsupervised  program  in  New  York  City. 

Chairman  Pepper.  Mr.  Blommer. 

Mr.  Blommer.  I  have  no  questions,  Mr.  Chairman. 

Chairman  Pepper.  Mr,  Waldie. 

Mr.  Waldie.  No  questions. 

Chairman  Pepper.  Mr.  Wiggins. 

Mr.  Wiggins.  Would  you  describe  the  workings  of  the  central  regis- 
try for  us  ? 

'  !  Dr.  GoLLANCE.  The  health  department  gets  all  the  information. 
Physicians  are  supposed  to  report  to  them  and  it  is  strictly  confiden- 
tial. I  would  say  most  of  their  records  are  gotten  through  arrest 
records.  When  arrested,  that  is  reported  to  the  central  registry.  Also, 
physicians  and  others  with  knowledge  are  required  to  report  this  to 
the  health  department. 

Incidentally,  Dr.  Dole  has  been  working  on  detoxifying  prisoners 
in  the  New  York  City  prison  and  at  nights  I  have  personally  observed 
that  at  least  two-thirds  of  the  prisoners  are  addicts  under  the  influence 
of  heroin. 

Mr.  Wiggins.  Can  you  describe  the  methadone  registry  for  the 
record? 

Dr.  GoLLANCE.  That  is  a  special  methadone  registry  under  the  di- 
rection of  Eockefeller  University.  This  registry  for  the  methadone 
patients  is  available  to  Dr.  Gearing  and  Dr.  Dole  at  Rockefeller.  Any 
patient  we  treat,  or  any  hospital  connected  with  us  must  report  every 
patient  into  this  central  computer.  We  finance  and  train  hospitals. 

One  thing  that  we  will  not  yield  on  in  any  way  is  that  they  must 
report  in  their  results  in  exactly  the  same  manner  as  we  do.  There  is 
standardized  reporting  in  our  program. 

However,  there  are  programs  that  do  not  report  to  this  central 
registry. 

Mr.  Wiggins.  That  is  all. 

Chairman  Pepper.  Mr.  Brasco. 

Mr.  Brasco.  Yes.  Could  you  tell  us,  Doctor,  how  long  is  the  waiting 
list  for  the  program  ?  -.iuAj-"ji\r  nfi  :  .■ 

Dr.  GoLLANCE.  It  varies.  It  used  to  be  very  long.  It  has  gotten  much 
shorter.  We  have  set  up  a  number  of  programs,  including  what  we  call 
rapid  induction.  We  are  working  now  on  what  we  call  a  holding  pro- 
gram. That  will  cut  down  waiting  time.  It  varies  from  weeks  "to 
months,  depending  on  the  area  in  which  the  patient  lives. 
;;Mr.  Brasco.  That  is  another  thing.  I  know  it  is  localized.  Coming 
Irom- New.  York,  I  had  an  opportunity  to  try  to  place  a  young  man 


246 

that  came  into  my  office,  and  I  was  sort  of  distressed  to  find  out  that 
the  program  he  was  talking  about  had  longer  than  a  5-month  waiting 
period  and  over  and  above  and  beyond  that  there  was  this  geographic 
thino-  where  they  said  we  don't  service  that  particular  area. 

Apparently  what  had  happened  is  one  program  that  had  some  open- 
ings said  we  don't  service  that  area  and  the  other  program  said  we 
don't  service  that  program. 

I  thought  it  was  all  your  program.  ^ 

Dr.  GoLLAXCE.  No ;  there  are  a  number  of  programs  m  New  York 
City.  We  are  in  four  boroughs.  We  have  others  besides  ours.  The  city 
has  opened  up  several,  the  Bronx  has  a  separate  program. 

In  our  own  network  we  have  14  hospitals,  30  clinics,  and  3,200  pa- 
tients. If  we  get  the  funds,  we  will  go  to  6,000  patients.  We  have  the 
means  now  to  expand.  We  have  trained  staff  to  act  as  a  nucleus  for 
expansion.  It  is  not  only  a  matter  of  money.  It  is  to  get  space,  to  train 
stall's,  to  get  people  willing  to  do  this  work.  I  think  we  are  over  most 
of  that  hurdle. 

Mr.  Brasco.  You  say  you  have  the  means.  You  say  you  have  3,200 
patients.  What  does  that  mean  ?  How  many  patients  can  you  convert 
if  you  have  the  money  and  you  have  the  staff  ? 

Dr.  GoLLANCE.  They  have  been  making  funds  available  now  and 
more  and  more  are  getting  into 

Mr.  Brasco.  How  many  additional  patients  would  that  be  ? 

Dr.  GoLLANCE.  If  we  get  what  we  ask  for  from  the  State — for  ex- 
ample, we  are  financed  entirely  by  the  New  York  State  Narcotics  Ad- 
diction Control  Commission — if  they  give  us  the  funds  we  will  jump 
from  3,200  to  6,000  this  year.  That  is  just  our  program. 

Mr.  Brasco.  One  last  question. 

The  diversion  of  methadone,  when  it  is  diverted  in  the  streets,  it  is 
used,  I  take  it,  as  a  substitute  for  heroin,  mainly  because  it  is  cheaper  ; 
is  that  the  reason  ? 

Dr.  GoLLANCE.  From  what  I  gather  from  all  the  addicts  I  have 
spoken  to,  they  do  not  take  methadone  as  a  drug  of  choice.  After  he  has 
become  addicted,  after  a  while,  the  addict  is  not  looking  for  the  highs. 
He  is  looking  to  be  comfortable.  He  doesn't  want  to  be  sick.  Methadone 
will  prevent  him  from  getting  sick. 

Mr.  Brasco.  So  that  what  you  are  saying^  then,  is  that  the  addict 
that  is  using  this  in  the  street,  when  methadone  is  diverted,  is  using  it 
in  the  same  way  that  he  would  use  it  in  your  program,  other  than  the 
fact  that  it  is 

Dr.  GoLL.\NCE.  He  is  trying  to  do  it  that  way  by  and  large.  There 
are  a  number  of  psychotic  individuals  around.  For  example,  our  ex- 
perience has  been  that  anybody  who  takes  heroin  after  8  weeks  in  our 
program,  usually  turns  out  to  have  a  serious  psychiatric  problem.  He 
doesn't  get  any  high  from  it.  He  is  a  needle  addict. 

Mr.  Brasco.  I  have  no  further  questions. 

Chairman  Pepper.  Mr.  Steiger. 

Mr.  Steiger.  No  questions. 

Chairman  Pepper.  Mr.  Mann. 

Mr.  Mann.  Qualified  personnel  is  a  problem  in  the  expanding  medi- 
cal field.  How  about  your  problems  ? 

Dr.  Gollance.  Well,  there  has  been  a  great  improvement  in  our 
program.  For  example,  we  are  getting  young  doctors  now  who  are 


247 

interested,  and  I  have  applications  from  doctors  to  join  the  program. 
I  don't  have  spots  for  them  right  now.  The  nurses  enjoy  doing  this 
work.  We  are  one  of  the  few  programs  that  doesn't  have  difficulty 
recruiting  nurses. 

The  counselors  are  flooded  with  requests  from  bright  young  people 
now  because  of  the  job  situation  and  we  can  get  a  good  calibre  of 
counseling.  We  are  not  having  problems  getting  personnel  that  we 
had,  maybe,  2  years  ago,  3  years  ago. 

Our  problem  now  is  boiling  down  to  money. 

Mr.  Maxn.  To  what  extent  do  you  use  ex-addicts  in  your  program  ? 

Dr.  GoLLANCE.  We  use  ex-addicts.  We  call  them  research  assistants. 
They  are  a  very  valuable  part  of  the  program.  We  have  a  very  limited 
number.  In  our  requirement  we  will  not  take  an  addict  right  from 
our  program  and  hire  him  as  a  research  assistant.  He  must  get  a  job 
and  show  he  can  hold  a  job  on  the  outside.  When  he  does,  we  can  hire 
him.  They  are  very  useful,  they  are  useful  as  a  model  to  the  new  patient 
in  explaining  the  program  to  the  new  patient,  useful  in  explaining  the 
addict  to  the  "square"  staff  that  we  hire.  So  they  are  very,  very  useful. 

Mr.  Mann.  Thank  you. 

No  further  questions,  Mr.  Chairman. 

Chairman  Pepper.  Mr.  Winn. 

Mr.  Winn.  Along  that  same  line,  what  difficulties  have  you  en- 
countered in  obtaining  physical  facilities  for  treatment  of  the  addicts  ? 

Dr.  GoLLANCE.  We  have  had  many  problems  in  that  area,  and  we 
use  any  physical  facilities  we  can  get.  We  use  stores,  brick  them  up. 
We  don't  call  them  storefronts  because  our  addicts  have  had  bad  ex- 
periences with  storefronts.  We  use  health  buildings,  office  buildings. 
We  even  set  up  a  program  in  a  church  and  are  looking  at  another 
church  to  get  space.  So  we  will  use  available  space. 

Now,  there  is  a  problem  in  getting  space.  We  go  into  a  community 
and  try  to  see  if  the  community  is  going  to  back  this  program.  They 
are  very  much  in  favor  of  it  but  don't  want  it  on  their  block. 

So  we  have  worked  that  out. 

In  the  Harlem  cormnunity,  fortunately,  we  don't  have  that  problem. 
We  have  been  able  to  open  up  a  great  many  clinics  and  we  are  expand- 
ing there. 

But  in  certain  other  areas,  it  is  a  problem. 

Mr.  Winn.  Do  you  use  the  residential  system  Dr.  Jaffe  referred  to  ? 

Mr.  GoLLANCE.  No ;  we  haven't  done  that.  Practically  all  our  patients 
are  treated  on  an  ambulatory  basis.  We  have  a  certain  number  of  beds 
for  those  who  have  difficult  problems  and  we  will  take  them  into  the 
hospital  for  6  weeks. 

We  also  have  a  medical  service  and  obstetrical  service  to  take  care  of 
the  patients. 

I  would  also  like  to  touch  on  that  because  this  comes  up.  We  think 
it  is  important  for  the  pregnant  addict  to  be  stabilized  on  methadone. 
Our  experience  is  that  the  pregnant  woman  stays  on  the  street  as  long 
as  she  can.  She  is  a  prostitute,  gets  no  prenatal  care,  takes  a  shot  of 
heroin  and  tries  ta  smuggle  some  heroin  in  with  her  when  she  enters 
the  hospital  for  delivery.  At  least  on  methadone  maintenance  they 
get  prenatal  care,  we  can  follow  them  carefully,  and  I  might  say  that 
methadone  has  brought  about  a  great  change  in  climate.  When  I  was 


248 

deputy  commissioner  of  hospitals,  it  was  recognized  that  pregnancy 
in  addicts  was  a  problem.  ,       i 

We  approached  the  chiefs  of  the  obstetrical  services  and  almost  to 
a  man  they  said  this  is  not  their  problem.  Now,  our  obstetricians  see 
these  cases.  They  are  much  interested  in  them  and  there  is  a  much 
better  climate  for  the.  pregnant  addict  than  what  existed  5  or  10  years 

Mr.  WioGiNS.  Incidentally,  does 'the  child  manifest  withdrawal 
symptoms? 

Dr.  GoLLANCE.  We  have  watched  them  very  carefully.  We  are  going 
to  follow  those  infants  for  a  long  time.  But  the  alternative  would  be 
they  would  have  heroin  withdra,wal  symptoms.  ■ '.  i 

Chairman  Pepper.  Doctor,  I  have  to  go  to  the  floor  for  a  little  while. 

I  will  ai^k  Mr.  Walrlie  if  he  will  be  good  enough  to  take. the  Chair. 

I  will  ask  you  one  question  and  make  one  comment..!  iiL-o  oi  \ 

How  is  your  program  financed  ?  >  ot/j  ^oiijj'rt'p.rr  vth  e-ij;  i  : 

Dr.  GoLLANCE.  Entirely  by  New  York  State  Addiction  Control 
Commission,  and  we  are  worried  very  much  about  future  financing. 

Chairman  Pepper.  Secondly,  on  behn.lf  of  the  committee  I  want  to 
express  our  very  deep  appreciation  for  your  coming  here  and  giving  us 
the  benefit  of  j^our  knowledge  and  experience. 

Dr.  GoiXANCE.  Thank  you.  It  is  a  privilege  to.  be  here. 

Mr.  Waldie  ( presiding) .  IMt. ISIurphy.         q  'jn'r 
'   Mr.  Murphy.  Yes.  ii  biifi  'jvorf 

What  experience  do  you  know  of  that  the  Army  has  had  with 
methadone? 

Dr.  Gollance.  I  don't'  know  the  Army's  experience.  I  know  the 
veterans  hospitals  in  our  area  have  been  very  interested.  I  have  spoken 
to  two  of  them.  One  of  them  is  setting  up  a  program.  I  would  think 
that  this  is  a  very  serious  problem.  I  am  not  an  expert  on  the  Army's 
situation.        q  aiiH  :;loj;J  ot  Bfiioi>.  •  /nmo'.  sdi  i  vij  i>  v 

I  had  one  nian  tell  me  the  main  reason  for  reenlistment  in  a  certain 
group  was  to  stay  in  the  Orient  where  they  could  get  heroin. 
"  Mr.  Murphy.  That  is  all.  -    ,,       ;        ; 

Mr.  Waldie.  Mr.  Eangel.  iiii /•  qir  k 

Mr.  Rangel.  Do  you  know  of  any  feasible  way  to  dispense  methadone 
in  such  a  form  that  it  cannot  be  reduced  to  another  substance  so  that 
it  can  be  used  intravenously  ?  .   ;>  - 

Dr.  GoLLANCE.  Well,  if  it  is  given  dissolved  in  Tang,  as  we  do,  or 
in  disket  form  it  can't  be  injected.      -        .    >      .j^i.  .  vi;. 

Mr.  Rangel.  But  we  discussed  tMte  earlier  'aiid  determined  that  it 
was  not  practical  to  do  this.  Is  there  any  other  form,  concrete  form, 
that  you  can  create  a  methadone  treatment  or  dosage  so  that  it  would 
be  impossible  for  the  patient  to  later  reduce  it  for  injection? 

Dr.  Gollance.  Well,  I  don't  think  they  can  reduce  either  of  these 
two  forms  we  use.  The  type  they  inject  are  the  pills  usually  gotten 
from  physicians.  They  are  the  usual*  medical  tablets  and  they  are  in-t 
jectable.  Perhaps  do  away  with  the  injectable  pills  might  be  one  way. 

Mr.  Rangel.  Are  you  saying  that  in  your  treatment  program  you 
don't  give  methadone  in  any  solid  form  at  all?    if^b  7o'1   [■>;<!-»;[  ^(Fi 

Dr.  GoLLANCE.  Only  in  this  disket  which  is  a  sj^ccial  form,  certain 
substances  are  put  there  so  it  leaved  a  sludge  so  it  won't  go  through  a 
needle. 


249 

Mr.  Hangel.  That  is  a  solid  form  ? 

Dr.  GoLLANCE.  It  is  a  solid  tablet.  It  is  dissolved  in  water.  It  is  like 
a  large  Alka-Seltzer  and  it  fizzes  up  and  it  leaves  a  sludge  and  they 
drink  it  when  dissolved. 

Mr.  Eangel.  If  all  of  methadone  was  required  by  law  to  be  dis- 
pensed only  in  the  form  in  which  you  dispense  it,  would  that  not 
eliminate  the  possibility  of  injections  ? 

Dr.  GoLLANCE.  Yes ;  and  I  might  point  out  that  methadone  is  a  diffi- 
cult drug  to  synthesize.  There  is  only  one  manufacturer  that  I  know 
of  in  thi^  country,  so  it  is  not  the  type  of  drug  that  you  can  bootleg 
and  make  it  surreptitiously. 

]\Ir.  Rangel.  Thank  you. 

Mr.  Waldie.  Thank  you. 

Are  there  any  other  questions  ? 

Doctor,  we  appreciate  very  much  your  appearance  before  the 
committee. 

(The  following  material  was  received  for  the  record  from  Dr. 
Gollance:) 

[Exhibit  No.  13(a)] 

Methadone  Maintenance  Treatment  Program 

(Reprinted  from  Maryland  State  Medical  Journal,  November,  1970,  Vol.  19,  pages 
74-77.  ©  1970  by  the  Medical  and  Chirurgical  Faculty  of  the  State  of  Maryland,  Baltimore, 
Maryland.  Printed  in  U.S.A.) 

By  Harvey   Gollance,   M.D.,   Associate  Director,   Beth   Israel  Medical   Center, 
Administrator,  Methadone  Maintenance  Treatment  Program,  New  York,  N.T. 

Drug  afldiction  has  reached  epidemic  proportions  in  Isfeio  York  City  and  in 
other  sections  of  the  United  States  as  well.  An  effective  treatment  for  severe  heroin 
addicts  known  as  the  methadone  maintenance  treatment  program  has  ieen 
developed  at  Rockefeller  University  and  has  continued  in  a  greatly  expanded 
program  at  the  Beth  Israel  Medical  Center  in  New  York. 

Facilities  for  the  treatment  of  narcotic  addiction  were  almost  nonexistent  in 
New  York  until  the  1950's.  It  was  then  that  the  increase  in  the  number  of  addicts 
in  the  low-income  areas  was  recognized,  as  was  the  increase  in  the  use  of  nar- 
cotics by  the  young.  Concerned  city  authorities  prompted  the  department  of 
hospitals  to  establish  facilities  for  adolescent  drug  users.  As  a  result,  a  140-bed 
hospital.  Riverside  Hospital,  was  opened  in  19.52.  Psychiatrists  and  strong  re- 
habilitative and  supportive  services  were  provided.  In  addition,  beds  were  ob- 
tained in  a  proprietary  hospital.  Manhattan  General  Hospital,  to  detoxify  nar- 
cotic patients.  With  one  exception,  the  chiefs  of  service  of  the  municipal  general 
care  hospitals  resisted  the  treatment  of  drug  addicts  in  their  service.  Few  physi- 
cians were  interested,  and  almost  all  refused  to  treat  the  addicts. 

A  study  was  done  by  Columbia  University  in  the  late  1950's  of  248  patients 
discharged  from  Riverside  Hospital.  It  showed  that  almost  100  percent  of  the 
patients  still  alive  became  readdicted  shortly  after  discharge.  Ray  E.  Trussell, 
M.D.,  director  of  the  School  of  Public  Health  and  Administrative  Medicine  of 
Columbia  University,  during  a  sabbatical  leave,  had  been  appointed  commis- 
sioner of  hospitals  of  New  York  City  in  1961.  Dr.  Trussell,  as  a  result  of  the 
Riverside  Hospital  study,  and  because  of  additional  serious  administrative 
problems,  decided  that  Riverside  Hospital  should  be  closed,  and  that  we  should 
seek  new  approaches  to  treat  drug  addicts.  Riverside  Hospital  was  closed  in 
196.3.  Although  it  had  given  its  patients  some  social  assistance,  it  failed  both  in 
preventing  readdiction  and  in  rehabilitating  its  patients.  It  seemed  clear  that 
the  answer  to  the  treatment  of  narcotic  addiction  lay  in  new  directions  to  be 
determined  by  future  research. 

research  encouraged 

The  Health  Research  Council  of  New  York  City  was  interested  in  encouraging 
research  in  the  area  of  drug  addiction,  and  in  1963  they  initiated  a  grant  to 

60-296—71 — pt.  1 17 


250 

two  Rockefeller  Institute  physicians:  Vincent  Dole,  M.D.,  a  specialist  in  meta- 
bolic research ;  and  Marie  PI  Nyswander,  M.D.,  a  psychiatrist  with  long  experi- 
ence in  drug  addiction. 

Dr.  Dole  and  Dr.  Nyswander  attempted  to  find  a  means  of  treating  a  patient 
which  would  enable  the  patient  to  function  productively  in  society.  The  research- 
ers considered  drug  addiction  as  a  psychological  disorder  and  thought  it  reason- 
able to  ask  whether  some  medication  might  control  the  drug  hunger.  At  first 
they  attempted  to  maintain  patients  with  morphine.  While  this  did  away  with 
much  of  the  patient's  antisocial  behavior,  it  did  not  make  him  productive.  Next, 
they  used  methadone  in  an  unusual  way,  giving  their  patients  gradually  increas- 
ing doses  until  the  tolerance  level  was  reached,  usually  between  80  to  lliO 
milligrams  daily.  When  patients  reached  this  maintenance  level,  usually  after 
6  weeks  of  treatment,  the  physicians  found  that  several  things  happened : 

(1)  The  patient  showed  no  harmful  effects  from  methadone.  He  was  neither 
sleepy  nor  high.  Medical  examination  and  all  types  of  medical,  physiological, 
and  psychological  testing  showed  no  harmful  effects  from  methadone. 

(2)  The  patient  lo:>t  his  drug  hungei*. 

(3)  The  effect  of  heroin  was  blocked.  Even  when  given  an  injection  of  heroin, 
the  patient  experienced  no  effects  from  it. 

(4)  The  dosage  of  methadone,  once  established,  remained  stable.  It  did  not 
have  to  be  increased,  and  was  long  acting  (24  to  3G  hours). 

GROWTH  OF  THE  METHADC>fE  PROBLEM 

After  intensive  study  and  experience  with  six  patients.  Dr.  Dole  went  to  Dr. 
Trussell,  showed  him  the  histories  of  his  six  patients,  and  asked  for  facilities  to 
expand  his  work.  In  19G5,  through  Commissioner  Trusseli's  efforts,  beds  were 
obtained  at  the  Manhattan  General  Hospital.  This  hospital  of  386  beds  later  was 
acquired  and  became  an  integral  part  of  the  Beth  Israel  Medical  Center.  This 
was  done  through  the  help  and  cooperation  of  the  president  of  the  Board  of 
Trustees  of  the  Beth  Israel  Medical  Center,  Mr.  Charles  H.  Silver.  In  19GG,  the 
center  was  renamed  the  Bernstein  Institute  of  the  Beth  Israel  Medici^.l  Center. 
It  is  the  largest  center  for  drug  addiction  under  voluntary  auspices.  Methadone 
maintenance  is  one  of  several  narcotic  programs  of  the  Bernstein  Institute. 

In  5  years,  the  Methadone  program  has  expanded  to  the  point  where  over  1,300 
patients  are  currently  being  treated  in  four  hospitals  and  15  clinics  under  the 
sponsorship  of  the  Beth  Israel  Medical  Center.  Several  additional  voluntary  and 
municipal  hospitals  and  clinics  are  now  almost  ready  to  join  the  Beth  Israel 
Methadone  Maintenance  Treatment  Program.  The  inpatient  phases  of  the  vrork 
are  done  either  at  Beth  Israel  or  at  Harlem  Hospital.  Clinics  have  been  estab- 
lished at  Beth  Israel  Medical  Center,  Harlem,  St.  Luke's,  and  Cumberland  Hos- 
pitals. In  addition,  a  number  of  hospitals  in  New  York  City  have  established 
their  own  methadone  programs  based  on  the  work  done  previously  at  the  Beth 
Israel  Medical  Center. 

This  program  considers  the  addict  a  patient  with  a  chronic  disease.  The  in- 
dividual whom  it  treats  is  the  hard-core  addict  who  suffers  from  euphoria  and 
drug  hunger,  is  unable  to  function  socially  or  economically,  and  must  take  drugs 
to  relieve  his  physical  misery. 

Naturally,  we  realize  that  it  would  be  best  if  the  cause  could  be  removed  and 
the  patient  made  drug-free.  But  all  programs  which  have  attempted  this  in  a 
community  setting  have  failed.  This  program  deals  with  the  symptoms.  The 
Methadone  blockade  against  opiates  frees  the  addict  from  his  drug  hunger  so 
that  he  becomes  receptive  to  rehabilitation.  It  should  be  stressed  that  this 
program  deals  with  the  long-term,  usually  ci'iminal  addict,  who  has  been  unable 
to  make  it  in  any  other  way.  Our  goal  is  social  rehabilitation  for  those  who  have 
been  unable  to  achieve  abstinence. 

TREATMENT  APPROACH 

The  Methadone  program  is  not  based  on  a  psychiatric  approach.  While  psy- 
chiatric consultation  is  needed  for  a  number  of  patients,  it  is  not  the  primary 
modality.  Our  experience  has  shown  that  the  program  is  equally  effective  in  a 
department  of  psychiatry,  medicine,  or  community  medicine.  The  important  fac- 
tor is  competent  direction  by  an  interested  physician.  Our  experience  has  also 
shown  that  there  should  be  available  good  medical  and  obstetrical  services  by 


251 

pliysicians  who  are  familiar  with  methadone  patients  and  who  are  available  for 
back-up  in  program. 

INTAKE    OF    PATIENTS 

A  central  intake  of  patients  for  all  the  clinics  and  h-^spitals  associated  with 
this  program  has  been  established  under  the  direction  of  a  skilled  staff.  This 
staff  has  had  experience  working  with  addicts,  and  their  backgrounds  are  essen- 
tially in  social  service.  They  screen  the  applicants  for  acceptability  in  the  pro- 
gram. A  research  assistant  (an  addict  in  the  program  who  has  proven  himself)  is 
of  great  assistance  in  this  procedure. 

Originally,  because  this  was  an  experimental  program,  very  rigid  qualifications 
for  admission  were  established.  These  subsequent  qualifications  and  their  modi- 
fications are : 

1.  Af7e.— Originally,  age  was  set  at  21  to  39  years.  The  patient  had  to  be  able 
to  sign  a  consent  form  but  could  not  be  over  39  because  of  the  theory  that  drug 
addiction  decreases  with  age.  The  age  requirement  has  now  been  changed  ro  18 
years  with  proper  consent.  No  maximum  age  limit  now  exists.  We  even  treat 
patients  collecting  Social  Security,  and  those  registered  with  medicare. 

2.  Residence. — ^New  York  City  residency  is  required  because  of  reimbursement 
aspects. 

3.  Addiction. — Only  opiate  addicts  are  accepted.  Severe  barbiturate  an<l  am- 
phetamine users  are  rejected,  as  well  as  are  those  with  multiple  addiction  (i.e., 
combination  of  opiates  with  barbiturates).  Hov/ever,  the  final  decision  for  accept- 
ance may  be  modified  by  the  clinician  in  charge. 

4.  Length  of  drug  use. — Originally,  a  minimum  of  5  years  of  mainlining  heroin 
was  set.  This  has  been  gradually  reduced  and  is  now  2  years. 

5.  Psychiatry. — Any  history  of  psychoses  or  severe  mental  disturbance  is 
usually  cause  for  rejection.  This  may  be  modified  by  the  clinician. 

6.  Addiction  in  family  unit. — If  the  patient's  spouse  is  addicted,  both  must  be 
eligible  and  admitted  together.  The  same  is  true  of  any  family  members  living 
in  the  same  household. 

7.  Alcoholism. — Severe  chronic  alcoholics  are  rejected. 

8.  Mental  deficiency. — Addicts  are  rejected  if  intelligence  quotient  is  so  low 
that  they  cannot  handle  the  responsibilities  of  the  program. 

9.  Medical. — Cirrhosis  of  the  liver,  diabetes,  epilepsy,  and  terminal  conditions 
were  originally  reasons  for  rejection.  We  now  have  no  medical  exclusions. 

10.  History  of  previous  unsuccessful  treatment. — This  has  now  l)een  modified, 
and  a  determination  is  made  according  to  the  judgment  of  intake  personnel. 

11.  Acceptance  of  patients. — Finally,  the  physician  in  charge  must  approve  the 
selection  of  the  patient. 

PROCEDURE 

When  it  has  been  determined  that  the  patient  meets  the  criteria  and  a  vacancy 
for  treatment  occurs,  he  is  admitted  into  a  phase  I  program.  Originally,  this  was 
a  6-week  period  of  hospitalization  on  an  open  ward.  This  phase  has  been  modi- 
fied and  now,  in  a  high  percentage  of  cases,  it  is  done  on  a  strictly  ambulatory 
basis.  The  patient  is  given  divided  doses  at  first.  As  the  dosage  is  increased,  and 
there  are  no  undesirable  side  effects,  the  dosage  schedule  is  changed  to  a  single 
daily  dose.  The  methadone  is  dissolved  in  an  orange  juice  substitute  and  taken 
orally. 

After  reaching  maintenance  level,  the  patient  is  next  assigned  to  a  phase  II 
clinic.  At  first,  the  patient  reports  daily.  He  leaves  a  urine  specimen  which  is 
tested  for  opiates  (heroin  and  morphine),  amphetamines,  quinine,  barbiturates, 
and  methadone.  He  drinks  his  dose  of  methadone  in  front  of  the  nurse,  and 
periodically  reports  on  his  activities  (for  example,  school,  work),  or  problems.  As 
the  staff  is  convinced  of  the  patient's  progress,  he  is  required  to  report  less  often — 
three  times  a  week,  twice  a  week,  then  once  a  week.  However,  when  he  does  rei»ort, 
he  drinks  that  day's  dose  of  methadone  in  front  of  the  nurse  (to  be  sure  that  he 
is  still  taking  it),  leaves  a  urine  specimen,  and  is  given  his  daily  supply  of 
methadone  for  those  days  when  he  does  not  report  to  the  clinic. 

We  try  to  limit  the  size  of  our  phase  II  clinic  to  less  than  100  patients.  Each 
clinic  has  a  part-time  physician,  a  nurse,  or  nurses  (depending  on  the  hours  of 
the  clinic),  a  supervisor,  counselors,  a  research  assistant  (ex-addict),  and  clerical 
personnel.  Backup  medical,  psychiatric,  pharmaceutical,  social,  legal,  and  other 
services  are  provided  when  needed. 


252 

It  is  during  pliase  II  that  serious  efforts  are  made  in  the  rehabilitation  of  the 
patient  A  wide  spectrum  of  services  is  offered  to  the  patient  in  the  areas  of 
medical  care  counseling  on  problems  of  everyday  life,  social  services  m  regard 
to  family  living  and  ■community  resources,  vocational  rehabilitation,  and  legal  de- 
fense advice.  The  older  patients  on  the  staff  are  especially  helpful  in  this  phase, 
and  are  constantly  available  to  help  with  problems  peculiar  to  addictive  patients. 

After  a  year  when  the  staff  is  convinced  that  the  patient  is  doing  well,  at  a 
job,  at  school,  'or  at  keeping  house,  and  the  patient  seems  to  have  no  problem 
with  alcohol  or  drugs,  he  is  assigned  to  a  phase  III  clinic.  The  treatment  is  essen- 
tially the  same,  but  the  frequency  of  visits  is  much  shorter  and  there  is  little 
need  for  the  counseling  staff.  These  services,  however,  are  available  if  needed. 

EVALUATION 

From  the  start,  in  1964,  this  program  has  had  independent  evaluation  of  all 
the  patients  who  have  ever  entered  it.  Originally,  when  the  city  financed  this 
program,  money  was  allocated  to  the  Columbia  School  of  Public  Health  to  per- 
form this  evaluation.  When  financing  of  the  methadone  maintenance  treatment 
program  was  assumed  by  the  State  narcotic  addiction  control  commission  in 
1967,  a  separate  contract  was  given  by  the  State  to  the  Columbia  University 
School  of  Public  Health  and  Administrative  Medicine  to  continue  this  evaluation. 
A  highlevel  committee  was  appointed.  The  charge  to  this  committee  was  to 
evaluate  the  results  of  this  program  in  an  objective  manner,  and  to  make  recom- 
mendations based  on  this  evaluation.  Frances  Rowe  Gearing,  M.D.,  was  appointed 
the  director  of  the  evaluation  unit. 

In  their  report  of  March  31,  1968,  the  committee  reached  these  conclusions : 
"The  results  of  this  program  continue  to  be  most  encouraging  in  this  group  of 
heroin  addicts,  who  were  admitted  to  the  program  on  the  basis  of  precise  criteria. 
For  those  patients  selected  and  treated  as  described,  this  program  can  be  con- 
sidered a  success.  It  does  appear  that  those  who  remain  in  the  program  have, 
on  the  whole,  become  productive  members  of  society,  in  contrast  to  their  previous 
experience  and  have,  to  a  large  extent,  become  self-supporting  and  demonstrate 
less  and  less  antisocial  behavior.  It  should  be  emphasized  that  these  are  volun- 
teers, who  are  older  than  the  average  street  addict  and  may  be  more  highly 
motivated.  Consequently,  generalizations  of  the  results  of  this  program  in  this 
population  to  the  general  addict  population  probably  are  not  justified.  There 
remains  a  number  of  related  research  questions  which  need  further  investigation." 

A  report  as  of  March  31,  1969,  showed  there  were  153  women  and  861  men  who 
had  been  under  observation  3  months  or  longer. 

"Among  the  women,  10  percent  were  employed  on  admission.  After  12  months, 
33  percent  were  employed.  Fourteen  percent  were  homemakers,  and  3  percent 
were  in  school.  After  18  months,  65  percent  were  employed,  in  school,  or  home- 
makers  and,  after  2  years,  this  percentage  had  increased  to  73  percent. 

"Among  the  men,  tlie  percent  of  those  employed  or  in  school  increases  from 
26  percent  on  admission  to  56  percent  at  12  mouths,  70  percent  at  24  months,  and 
S3  percent  at  3  years.  The  percent  of  men  on  welfare  or  supported  by  others  de- 
creases proportionately  from  54  percent  at  6  months  to  44  percent  at  12  months, 
30  percent  at  24  months,  and  17  percent  at  36  months. 

"The  arrest  records  of  those  who  enter  the  methadone  program  and  those  who 
enter  our  detoxification  program  are  similar.  Patients  who  are  accepted  have  to 
wait  a  long  period.  Acceptance  into  the  program  does  not  have  a  marked  effect 
on  their  pattern  of  arrest  in  the  12  months  prior  to  admission.  Following  admis- 
sion, there  is  a  marked  decrease  in  arrests  while  the  pattern  of  arrest  among 
the  contrast  (detoxification)  group  is  very  similar  to  earlier  patterns." 

None  of  the  patients  who  remained  in  the  program  have  become  readdicted 
to  heroin.  Problems  with  drug  abuse  (amphetamines  and  barbiturates)  varied 
from  4  percent  to  12  percent. 

The  methadone  maintenance  treatment  program  is  an  effective,  economical  way 
of  treating  hard-core  heroin  addicts  who  cannot  be  treated  successfully  with  any 
existing  programs.  It  can  now  be  done  on  an  entirely  ambulatory  basis  for  most 
patients.  This  makes  the  program  feasible  for  those  areas  where  inpatient  beds 
are  difficult  to  obtain.  We  feel  it  is  very  important  that  this  program  be  a  struc- 
tured one  so  that  it  i-emains  carefully  controlled. 

Methadone  maintenance  treatment  for  heroin  addiction  is  a  public  health  pro- 
gram. It  should  be  accomplished  under  the  direction  of  a  public  health  deijart- 
ment,  a  hospital,  or  an  organized  uiodical  facility.  Since  rehabilitation  and  social 
productivity  of  the  patient  is  the  prime  objective  of  this  program,  it  is  important 


253 

that  the  means  to  do  this  must  be  an  integral  part  of  the  program.  It  is  not  suffi- 
cient to  prescribe  methadone  alone. 

Under  these  circumstances,  the  addict  is  given  a  chance  in  a  program  which  he 
is  capable  of  handling,  and  which  offers  him  a  realistic  path  to  living  as  a  respon- 
sible member  of  his  community  and  of  society  without  the  crutch  of  heroin. 

Mr.  Lichtman,  whose  statements  follow,  is  a  research  assistant  at  the  Beth 
Israel  Medical  Center.  Before  becoming  an  assistant  there,  he  was  a  drug  addict. 
In  conjunction  with  Dr.  Gollance's  article  on  the  methadone  maintenance  pro- 
gram, Mr.  Lichtman  tells  how  the  program  has  helped  him. 

I  am  29  years  old.  I  started  using  heroin  at  the  age  of  15.  I  used  it  for  a  period 
of  approximately  10  years.  Approximately  4  of  those  years  were  served  as  a 
guest  of  the  city.  State,  and  Federal  governments  in  any  number  of  institutions. 

After  a  period  of  10  years,  I  found  that  a  strange  thing  happened  to  me.  I  devel- 
oped a  certain  motivation  which  I  had  not  had  during  that  time.  I  decided  that 
I  wanted  something  more  than  I  had  had  for  those  10  years.  I  came  to  the  Beth 
Israel  Medical  Center  in  April  1966,  at  which  time  I  applied  for  the  methadone 
maintenance  program.  The  reason  that  I  had  originally  applied  for  that  program 
is  that  I  had  unsuccessfully  tried  other  methods  of  treatment  when  coming  out 
of  institutions  in  other  programs.  I  found  that  the  same  drug  craving  which  I 
liad  in  going  into  a  program  would  return  upon  my  release  from  an  institution. 

I  had  heard  many  stories  about  methadone.  I  heard  that  while  taking  methadone 
you  are  still  addicted,  and  you  would  not  be  able  to  function  in  the  cuiiim unity. 
But  I  decided  that  since  I  had  not  been  able  to  function  in  the  other  prograni.s, 
that  I  wonld  try  methadone. 

As  I  said,  I  went  into  the  hospital,  and  stayed  there  for  a  period  of  6  weeks, 
during  which  time  the  metl'adone  level  was  increased. 

After  leaving  the  hospital,  I  returned  to  my  family,  who  were  skeptical.  My 
father  owns  his  own  business  in  Manhattan.  He  is  a  furrier  and  does  make  a 
good  living.  During  the  19  years  I  was  using  drugs,  he  did  not  allovs-  me  into 
his  place  of  business.  When  I  returned  there  from  the  methadone  program,  as 
I  ?aii\.  he  was  skeptical,  but  was  willing  to  take  a  chance  with  me. 

I  lived  at  home  for  4  months,  at  which  time  I  met  a  young  lady  who  was 
also  willing  to  take  a  chance  with  me  and  who  knew  my  background.  After 
about  6  months,  we  were  married. 

I  now  have  a  lovely  home  in  Riverdale,  and  a  new  car.  I  work  for  the  pro- 
gram in  helping  other  addicts  attain  that  which  I  have  attained. 

I  find  there  is  no  real  "hang-up"  in  using  methadone.  I  leave  a  urine  specimen 
when  I  come  into  the  clinic  weekly  and  pick  up  six  bottles  of  medication  to 
take  hnme  with  me,  which  I  take  at  my  leisure.  Methadone  is  a  long-acting  drug. 
I  take  the  drug  at  any  time  during  the  day,  and  sometimes  forget  to  take  it 
and  then  overlap  hours.  The  drug  lasts  anywhere  from  24  to  30  hours.  I  have 
never  experienced  any  withdrawal  symptoms. 

As  I  say,  there  is  no  drug  craving,  and  no  outw^ard  appearance  of  euphoria. 
^Methadone  does  not  produce  these  symptoms  as  other  opiate  drugs  do. 

In  the  time  I  have  been  on  the  methadone  program,  I  find  that  there  are  many 
people  who  are  willing  to  take  a  chance  on  the  addict  population  once  they 
(the  addicts)  are  stable  on  it,  that  is,  the  maintenance  drug.  In  New  York  City 
alone  we  have  many  large  organizations,  such  as  the  telephone  company  and 
large  construction  firms,  who  are  willing  to  employ  some  of  our  people  in  the 
program. 

It  is  difficult  for  me  to  tell  you  all  of  the  things  that  have  happened  to  me 
in  the  past.  I  have  a  new  life  today  and  it  is  something  that  T  was  never  able  to 
have  before. 


[Exhibit  No.  13(b)] 

Beth  Israel  Medical  Center, 
Methadone  Maintenance  Treatment  Program, 

New  York,  N.Y.,  May  7,  1971. 
Mr.   Chris  Nolde. 

Associate  Covnsel,  House  Select  Committee  on  Crime, 
Washington,  B.C. 

Dear  Mr.  Nolde  :  Following  are  my  comments  concerning  the  statements  of 
Mr.  Horan : 

1.  We  agree  that  private  physicians  should  be  regulated  in  their  use  of  metha- 
done for  maintenance  ;  but  we  should  be  careful  not  to  impede  the  development  of 


254 

well-structured  methadone  maintenance  programs  because  of  the  improper  use 
of  methadone  by  private  physicians. 

2.  Methadone  in  injectable  form  (Dolophine)  has  been  available  in  the  legal 
and  illicit  markets  for  a  long  time.  It  is  inaccurate  and  misleading  to  ascribe 
methadone  overdoes  in  any  community  to  the  existence  of  methadone  programs 
alone  since  Dolophine  has  been  available  for  many  years  and  is  still  available 
in  the  illicit  market.  Most  structured  programs  do  not  use  Dolophine  in  pill 
form. 

3.  Although  methadone  maintenance  is  not  the  treatment  of  choice  for  all  ad- 
dicts, it  should  be  available  for  those  for  whom  it  is  the  treatment  of  choice. 

(a)  We  have  changed  our  admission  criteria  as  follows  : 

(1)  Minimum  age  requirement  has  been  reduced  from  20  to  18  years. 

(2)  Number  of  years  of  verified  addiction  has  been  reduced  from  4  to  2 
years. 

We  made  these  changes  in  order  to  make  this  treatment  available  to  the 
younger  patient  who  is  already  thoroughly  addicted  to  heroin ;  in  this  v\-ay  we 
can  treat  the  younger  patients  who  need  the  program  without  addicting  persons 
to  methadone  who  are  not  already  clearly  addicted  to  heroin. 

(b)  We  find  that  most,  if  not  all  of  our  patients,  have  been  treatment  failures 
in  other  programs;  but  this  is  not  an  absolute  prerequisite  for  admission. 

4.  We  agree  that  every  effort  must  be  made  to  screen  out  any  applicant  v.'ho 
is  not  already  addicted  to  heroin. 

5.  Therapeutic  communities  and  residential  treatment  mentors  are  modalities 
of  choice  for  young  and  nonaddicted  users  of  heroin.  Communities  containing 
a  significant  number  of  addicted  persons  should  provide  programs  designed  to 
meet  their  specific  problem,  including  heroin  addiction. 

6.  Part  5  of  the  statement  reads  in  part :  "We  find  many  provable  cases  of 
injection  directly  into  the  vein  of  methadone  mixed  with  juice  or  Tang."  I  have 
checked  with  our  clinical  staff  to  make  sure  that  my  impression  is  correct  and 
it  is  their  opinion  that  the  following  is  correct :  Methadone  mixed  with  juice  or 
Tang  is  nouinjectable  for  several  reasons  which  I  think  are  too  technical  to  go 
into  here,  but  the  fact  is  that  the  drug  in  this  form  is  not  injectable  and  any 
patient  who  succeeded  in  injecting  it  would  become  fatally  ill. 

I  would  emphasize  that  there  is  a  large  group  of  chronic  heroin  users  for  whom 
all  existing  treatment  programs  except  methadone  maintenance  have  been  a 
failure. 

The  goal  should  be  to  set  up  structured,  controlled  programs  and  not  to  deny 
the  seriously  heroin  addicted  this  proven  program  which  is  literally  lifesaving. 
both  for  the  patient  and  the  community. 
Sincerely  yours, 

HaPwVey  Gollance,  M.D. 

Asfnciatc  Director, 
(In  charge  of  narcotic  trcatmcitt  proyranis). 


[Exhiliit  Xo.  13(c)] 

FoRTY-NiNTii  .Judicial  Distuict, 
Counties  of  Dimmit,  Wekb,  Zapata, 

Laredo,  Tex.,  November  11,  1070. 

Vincent  P.  Dole.  M.D., 

Rockefeller  I 'nirer.sity, 

New  York,  N.Y. 

Dear  Sir:  This  is  to  notify  you  that  a  complete  check  of  our  district  court 
records  reveal  tiie  following  in  connection  with  cases  involving  burglary  and 
theft,  theft,  aggravated  assault,  forgery,  under  the  infiuence,  and  other' pettv 
theft  cases. 

Our  records  reflect  that  since  the  inception  of  the  methadone  maintenance  pro- 
gram in  Laredo.  Webb  County.  Tex.,  the  reduction  in  this  type  of  crime  has 
dropped  approximately  05  percent. 
Very  truly  yours, 

Carlos  V.  P.EXAvinES,  Jr., 
A.'iS'Stant  District  Attorney. 


Chairman  PEPPEr..  The  next  witness  is  Mr.  Robert  F.  Iloran. 

Mi\  Horan  is  the  Commonwealth  attorney  for  Fairfax  County,  Va, 

Mr.  Iloran  is  a  native  of  New  Brunswick,  N.J.  He  attended  Mount 
St.  Mary's  College,  Emmitsburg,  Md.,  where  he  received  liis  B.S. 
degree  in  1954.  Following  graduation,  he  was  commissioned  a  second 
lieutenant  in  the  U.S.  IMarine  Corps  and  served  as  a  Marine  officer 
until  1958.  Upon  leaving  active  service,  he  entered  Georgetown  Univer- 
sity Law  School  and  earned  his  LL.B.  degree.  He  served  as  an  assistant 
Commonwealth's  attorne_v  during  1964  and  1965.  In  September  1965 
he  resigned  as  assistant  Commonwealth's  attorney  to  become  a  partner 
in  a  Fairfax  law  firm.  His  law  partnership  terminated  in  March  1967, 
when  the  circuit  court  appointed  him  Commonwealth's  attorney  to  fill 
an  unexpired  term,  and  in  November  1967  he  was  elected  to  that  office 
for  a  term  of  4  years. 

Mr.  Horan  is  a  member  of  the  Virginia  State  Bar,  National  District 
Attorney's  Association,  Northern  Virginia  Trial  Lawyers  Association, 
Delta  Theta  Phi  Legal  Fraternity,  the  Marine  Reserve  Officers  As- 
sociation, and  the  Young  Democratic  Club  of  Fairfax  County.  He  is 
a  member  and  former  secretary  of  the  Fairfax  County  Bar  Associa- 
tion. Mr.  Horan  is  first  vice  president  of  the  Virginia  Commonwealth's 
Attorney's  Association,  and  in  March  of  1970  he  becam.e  the  first 
elected  chairman  of  the  Northern  Virginia  Criminal  Justice  Advisory 
Council. 

Mr.  Horan,  we  welcome  your  testimony. 

STATEMENT  OF  EOBEET  F.  HOEAH,  JE„,  COMMOITWEAITI!  ATTOE- 
NEY  FOE  THE  COTJI^ITY  OF  FAIRFAX,  C0MM0IW7EALTH  OF  VIE- 
GINIA 

Mr.  Horan.  Thank  you,  Mr.  Chairman. 

I  am  the  chief  criminal  prosecutor  for  a  jurisdiction  containing 
upward  of  one-half  million  people.  Prior  to  the  year  1967,  drug  abuse 
as  a  problem  in  what  is  essentially  a  suburban  jurisdiction  was  prac- 
tically nonexistent. 

Commencing  in  the  fall  of  1966  and  early  1967,  we  had  our  first 
onset  of  drug  abuse,  as  did  most  of  suburban  America.  One  of  the 
significant  things  that  has  happened  to  us  and  is  pertinent  for  this 
comniittee  is  that  in  the  last  18  months  in  that  jurisdiction  we  have 
had  five  provable  methadone  overdose  deaths.  We  have  had  tv/o  others 
that  are  probably  methadone  deaths.  In  the  same  period  of  time  we 
only  had  one  heroin  overdose  death. 

r  am  here  today  because  of  my  increasing  concern  about  the  direc- 
tion in  which  we  are  being  pushed  in  the  area  of  methadone  main- 
tenance. It  seems  that  everyone  articulates  the  position  that  metha- 
done is  not  the  panacea  for  heroin  addiction,  and  yet  in  some  quarters 
it  seems  that  that  is  exactly  how  we  are  treating  it. 

In  my  opinion,  the  news  media  has  added  massively  to  the  con- 
fusion concerning  this  drug.  I  sometimes  get  the  feeling,  and  that 
feeling  was  amplified  by  the  WTOP  editorial  last  week,  that  some 
feel  that  methadone  equals  rehabilitation,  and  if  a  jurisdiction  does 
not  have  a  methadone  maintenance  program  they  are  simply  not  in 
the  rehabilitation  business.  WTOP's  view,  in  my  opinion,  is  patently 


256 

nonsense  and  serves  only  to  add  confusion  to  an  already  confused 
situation. 

The  confusion  is  not  alleviated  when  a  physician  can  stand  before 
this  committee,  as  one  did  in  October  of  1970,  and  state  that  the  use 
of  methadone  in  treatment  is  "paralleled  in  importance  only  by  the 
discovery  of  penicillin  during  this  century."  I  don't  know  what  the 
founder  of  the  polio  vaccine  feels  about  that  statement,  but  it  strikes 
me  as  grossly  misleading. 

First  of  all,  I  would  like  to  make  clear  that  I  support  a  properly 
run  and  properly  controlled  methadone  treatment  pi'ogram.  Basically 
I  support  the  original  concepts  of  the  program  of  Dr.  Vincent  Dole, 
in  New  York  City.  I  firmly  believe  that  with  a  certain  class  of  addict, 
there  is  nowhere  to  go  but  up.  On  the  other  hand,  I  believe  that  many 
of  the  original  Dole  concepts  have  been  prostituted  on  the  altar  of  the 
simple  solution.  Tliei'e  is  too  much  of  an  attitude  in  some  quarters  to 
consign  anyone  and  everyone  who  has  used  heroin  to  methadone  main- 
tenance, regardless  of  his  state  of  addiction.  Even  Vincent  Dole  admits 
that  this  method  of  treatment  may  consign  its  participants  to  a  lifetime 
of  methadone  addiction,  since  this  compound  is  a  physically  addictive 
one.  I  oppose  such  an  easy  consignment  for  two  basic  reasons : 

One,  because  of  the  nature  of  hard  narcotic  use  and  the  hard  nar- 
cotic users  that  we  find  in  suburban  Virginia — and  I  suspect  that  the 
same  would  be  true  in  most  of  suburban  America — and  two,  the  in- 
creasing availability  of  this  compound  as  a  prime  abuse  drug. 

In  connection  with  the  first  reason,  it  is  important  to  remember  some 
of  Dr.  Dole's  original  guidelines. 

(1)  The  addict  should  be  at  least  20  years  of  age ; 

(2)  He  should  have  at  least  4  years  mainline  hard-narcotic  addic- 
tion; and 

(3)  Other  methods  of  treatment  must  have  been  tried  and  failed 
before  he  would  be  committed  to  maintenance. 

I  would  suggest,  members  of  the  committee,  that  very,  very  few 
addicts  in  sulmrban  America  would  meet  just  those  three  guidelines. 
In  my  jurisdiction.  77  percent  of  all  our  drug  abuse  cases,  regardless 
of  drug,  involves  those  aged  20  and  below.  The  phenomena  of  drug 
abuse  hit  us  in  1966,  while  heroin  abuse  did  not  hit  us  until  1969,  in 
the  spring.  The  net  effect  of  this  is  that  today  virtually  all  of  our 
heroin  users  have  less  than  2  years'  mainline  addiction.  Most,  if  not  all 
of  them  are  below  age  20 ;  and  when  they  first  come  to  our  attention, 
no  other  method  of  treatment  has  been  tried  in  an  attempt  to  cure  them. 
Thus  we  can  see  that  most  of  our  addicts,  and  I  use  the  term  loosely,  do 
not  meet  Vincent  Dole's  original  guidelines. 

My  concern  is  that  in  the  search  for  the  panacea  for  hard-narcotic 
abusers  we  might  consign  to  a  lifetime  of  methadone  maintenance 
some  very  young  kids  without  ever  attempting  another  route  of  cure. 
In  my  opinion,  very  few  kids  in  my  jurisdiction  should  be  so  consigned. 
An  analogy  to  "throwing  out  the  baby  with  the  bath  water"  might  fit 
our  situation. 

I  would  not  for  1  minute  contest  the  right  of  the  District  of  Columbia 
or  New  York  City  to  commit  themselves  fully  to  massive  methadone 
maintenance  programs.  But  please,  for  Heaven's  sake,  let's  not  commit 
the  rest  of  the  country. 


257 

I  guess  I  have  read  most  of  what  Drs.  DiiPont  and  Dole  say  about 
their  programs,  and  their  writings  certainly  substantiate  their  commit- 
ment— but  their  special  jurisdictional  needs  appear  to  require  it — my 
jurisdiction  does  not,  and  I  suspect  that  the  rest  of  suburban  America 
is  in  my  situation  and  not  in  theirs. 

We  presently  have  in  Fairfax  County  a  drug  treatment  program 
based  upon  the  therapeutic  community  concept. 

We  have  been  in  the  business  for  quite  some  time  now.  We  are  satis- 
fied with  our  methods  of  treatment,  and  if  there  comes  a  time  when  we 
have  a  large  scale  number  of  hard-narcotic  abusers,  then  we  are  prob- 
ably going  to  take  a  much  harder  look  at  methadone.  But  that  is  not 
our  situation  today. 

The  second  problem  in  northern  Virginia  involves  the  use  of  metha- 
done as  a  prime  abuse  drug.  Supposedly,  the  situation  will  be  alleviated 
by  FDA  regulations  which  may  control  the  dispensing.  I  hope  those 
guidelines  do  that,  because  prior  to  any  guidelines  our  situation  was 
atrocious.  In  the  spring  of  1970  the  Fairfax  Police  Department  and  I, 
after  our  second  methadone  overdose  death,  began  to  complain  about 
the  availability  of  this  drug  in  the  marketplace.  Unfortunately,  three 
more  deaths  were  necessary  before  anything  was  done  to  tighten  up 
dispensing  guidelines  in  the  District,  and  two  of  those  deaths  involved 
kids  16  years  of  age. 

We  have  tried,  through  the  treatment  program,  the  police  depart- 
ment and  my  office,  to  evaluate  our  situation  with  regard  to  the  avail- 
ability of  methadone.  I  would  like  to  share  with  you  some  of  the  find- 
ings that  we  made,  based  on  a  cold,  hard  look  at  it  in  the  past  year. 

First.  Large  supplies  of  this  drug  have  been  coming  out  of  the  Dis- 
trict of  Columbia,  primarily  from  private  practitioners'  offices.  Much 
of  this  methadone  has  been  diverted  into  abuse  circles  and  in  some 
cases  it  has  become  the  drug  of  choice.  Some  of  it  is  being  sold  right 
in  the  syringe  at  $1.,50  a  cubic  centimeter.  This  makes  it  an  excellent 
profit  drug  and  as  much  as  in  the  case  of  at  least  one  physician,  he 
distributes  50  cubic  centimeters  at  a  time  at  $15  a  throw. 

Upon  resale  of  that  at  a  $1.50  a  cubic  centimeter  the  profit  is 
apparent. 

Mr.  Peeito.  Mr.  Horan,  has  this  doctor  been  prosecuted? 

Mr.  HoRAN.  To  my  Imowledge  he  has  not.  We  have  no  jurisdictional 
control  over  him. 

In  the  District  of  Columbia  he  can  do  exactly  what  he  is  doing. 

Mr.  Perito.  Have  you  recommended  to  the  District  authorities  that 
he  be  prosecuted? 

Mr.  Horan.  I  have  had  a  great  deal  of  contact  with  the  narcotics 
squad  over  the  year,  and  the  district  attorney's  office,  and  they  feel 
their  hands  are  somewhat  tied.  That  is  the  impression  I  get. 

Mr.  Sandman.  Why  are  they  tied  ? 

Mr.  HoRAN.  Because,  evidently,  under  the  existing  regulations  he 
can  maintain  an  addict  on  methadone  because  he  is  making:  a  purely 
medical  iudgment,  and.  therefore,  it  is  not  criminal  under  District  law. 

Mr.  Waldie.  Mr.  Horan,  may  I  interrupt  you  ? 

We  are  in  the  middle  of  a  quorum  call.  I  would  like  to  have  you 
complete  your  statement  before  the  end  of  the  second  bell.  Perhaps 


258 

you  best  complete  your  statement  and  then  we  will  come  back  for 
inquiries. 

Mr.  HoRAX.  The  second  thing  we  find  is  a  number  of  cases  of  non- 
heroin  addicts  being  dispensed  methadone  in  the  District  of  Colum- 
bia from  private  practitioners.  These  are  kids  that  weren't  addicts 
to  begin  with,  and  they  are  getting  methadone  without  being  a  true 
addict. 

You  may  have  read  about  the  reporter  from  the  Northern  Virginia 
Sun  who  had  never  had  a  narcotic  in  his  life,  came  over  here,  plunked 
down  $15  and  he  got  methadone  in  a  hand}'  carryout  dose. 

Third.  Methadone  addiction  appears  to  be  growing  at  a  faster  rate 
than  heroin  addiction.  Our  drug  treatment  program  over  the  past 
year  found  it  necessary  to  engage  in  medical  detoxification  of  39  pa- 
tients. Thirteen  of  these  were  detoxified  for  a  heroin  habit  and  26 
were  detoxified  for  a  methadone  habit.  A  large  majority  of  those  de- 
toxified were  below  age  20. 

Fourth.  Some  of  the  users  were  obtaining  methadone  by  going  to 
one  physician  on  one  da^?-  and  a  different  physician  a  couple  of  days 
later.  This  resulted  in  their  being  able  to  obtain  a  weekly  supply  from 
each  physician  in  the  same  week. 

Fifth.  Dr.  Vincent  Dole  originally  felt  that  one  of  the  main  reasons 
for  dispersing  methadone  diluted  in  fruit  juice  was  that  nobody  would 
shoot  it.  We  find  many,  many  provable  cases  of  injection  directly  into 
the  vein  of  methadone  mixed  with  juice  or  Tang. 

As  a  matter  of  fact,  the  interior  of  the  lungs  of  one  of  the  recent 
death  cases  was  coated  with  a  material  that  was  consistent  with 
methadone  abuse.  There  is  only  one  way  to  get  that  on  the  interior 
lining  of  the  lungs,  and  that  is  through  a  vein. 

Many  cases  of  nonfatal  overdose  began  to  show^  up  simply  because 
methadone  was  entirely  too  much  drug  for  the  drug  abusers  in  our 
area,  particularly  when  it  was  being  injected  rather  than  taken  orally. 
An  addict  may  have  been  getting  2-  or  3-percent  heroin  in  his  vein 
and  all  of  a  sudden  he  is  getting  a  relatively  pure  drug  in  methadone 
and  his  central  mervous  system  can't  stand  it.  His  respiratory  system 
fails,  he  stops  breathing. 

Sixth.  A  great  number  of  our  citizens  were  not  even  aware  that 
their  youngsters  were  involved  in  a  so-called  methadone  treatment 
program  in  the  District.  Their  kids  were  in  treatment  programs.  They 
didn't  know  the  treatment  involved  the  daily  dispensing  of  phj-sically 
addicting  narcotics. 

In  conclusion  I  want  to  say  that  methadone  maintenance  probably 
does  have  a  proper  place  and  is  the  only  mode  of  treatment  in  sonic 
cases.  However,  I  strongly  endorse  the  caveat  of  this  committee,  at 
page  82  of  its  report  of  January  2,  1971,  entitled  "Heroin  and  Heroin 
Paraphernalia,"  where  in  this  committee  said : 

Every  precaution  against  diversion  mnst  be  olxserved.  While  we  believe  tliat 
drug  should  be  reclassified,  we  do  not  believe  that  individual  private  practitioners 
should  be  allowed  to  prescribe  methadone  for  prolonged  maintenance  of  indi- 
vidual heroin  addicts. 

The  footnote  to  that  caveat  gets  to  the  heart  of  tlie  issue,  in  my  opin- 
ion, where  tliis  committee  states:  "Methadone  maintenance  must  be 
accompanied  b}'  proper  psychiatric,  social,  and  vocational  services.'' 


259 

-  I  would  only  add  to  that  the  suggestion  that  maintenance  should  not 
be  the  original  mode  of  treatment  except  in  an  isolated  class  of  cases ; 
and  secondly,  that  in  the  case  of  many  young  suburban  abusers  proper 
psychiatric,  social,  and  rocational  services  will  obviate/ tjiie  necessity 
of  maintenance  to  begin  with.  \  ■,  .,. 

Mr.  Waldie.  Thank  you,  Mr.  Ploran. 

There  will  be,  I  am  sure,  a  number  of  questions  to  be  asked  of  you. 
Hopefully  we  v^^ill  reconvene  at  1  o'clock. 

The  committee  will  remain  in  recess  until  that  time. 

(Thereupon  the  committee  recessed  to  reconvene  at  1  p.m.) 

Afternoon  Session 

Mr.  Mann  (presiding).  The  committee  will  come  to  order. 

Prior  to  the  recess,  Mr.  Horan  was  testifying  and  we  will  resume 
his  testimony. 

Mr.  Horan,  you  had  completed  your  statement  in  chief  ? 

Mr.  Horan.  Yes ;  I  have,  sir. 

Mr.  Mann.  All  right ;  Mr.  Perito,  will  you  inquire  ? 

Mr.  Perito.  Thank  you,  Mr.  !Mann. 

Mr.  Horan,  I  assume  from  your  testimony  that  you  are  not  opposed 
to  properh^  run  methadone  programs ;  is  that  correct  ? 

Mr.  HoKAN.  Tliat  is  correct. 

j\Ir.  Perito.  It  is  the  thrust  of  your  testimony  then,  if  I  underst.md 
it,  that  you  consider  that  your  problem  is  different  from  the  problem 
in  the  District  of  Columbia  or  in  New  York  City;  would  that  be 
correct  ? 

Mr.  HoRAN.  I  certainly  think  that  is  so,  predominantly  because  I 
think  we  have  a  different  breed  of  addict  than  New  York  City  has, 
sir. 

]Mr.  Perito.  Would  NTA  be  the  type  of  program  that  you  point  to  as 
an  example  that  you  could  support  ? 

Mr.  HoRAN.  That  may  be  a  little  far. 

From  the  point  of  view  of  the  one  issue  of  the  ability  to  di\'ert 
methadone  into  drug  abuse  circles,  I  have  no  evidence  that  we  have 
ever  seen  any  methadone  in  our  area  that  has  come  out  of  NTA. 

From  that  point  of  view  I  am  satisfied  with  the  NTA  controls  at  this 
point  in  time. 

On  the  second  issue,  my  difficulty  with  NTA  is  that  they  appefir  to 
be,  on  the  surface,  entirely  too  methadone  prone.  That  seems  to  be 
the  big  thing  with  them  as  opposed  to  what  I  think  is  a  growing  tend- 
ency in  research  programs  to  indicate  that  different  modes  of  treat- 
ment are  necessary. 

Mr.  Perito.  And  you  believe  that  the  propensity  toward  methadone 
distribution  in  a  clinical  setting  causes  you,  as  a  prosecutor,  problems? 

Mr.  Horan.  Yes ;  I  think  so. 

Mr.  Perito.  And  those  problems  come  from  diversion  ? 

Mr.  Horan.  They  come  from  diversion.  They  also  come  from  '^he 
psychological  attitude,  if  you  will,  that  methadone  is  the  cure,  and  vou 
find  an  awful  lot  of  addicts,  who  discover  it  really  isn't  the  cure,  it  is 
just  another  drug  for  those  addicts.  It  just  continues  to  be  a  difficult 
criminal  problem. 


260 

Mr.  Pertto.  Based  upon  your  experience,  have  you  found  diver- 
sion on  a  manufacturing  level  in  Fairfax  County  ? 

Mr.  HoRAN.  No ;  we  have  not. 

Mr.  Perito.  I  assume  that  based  upon  your  experience  your  diver- 
sion is  found  on  the  low  levels  of  dispensing,  say  from  private 
physicians? 

Mr.  HoRAN.  Almost  entirely  private  practitioners. 

Mr.  Perito.  Have  you  found  any  evidence  of  diversion  on  the  drug- 
store level? 

Mr.  HoRAx.  There  is  a  recent  report  by  the  Virginia  Board  of  Phar- 
macy. An  investigator  who  did  a  report  for  the  Virginia  Board  of 
Pharmacy  found  virtually  no  diversion  anywhere  in  the  State. 

Mr.  Perito.  So  it  is  fair  to  say  that  ordinarily,  and  based  on  your 
experience,  the  diversion  which  causes  you  problems,  as  a  prosecutor, 
comes  from  private  physicians  ? 

Mr.  HoRAN.  Yes ;  it  does. 

Mr.  Perito.  Based  upon  your  experience,  how  do  you  think  that 
diversion  problem  can  best  be  handled  ? 

Mr.  HoRAN.  I  feel  at  this  point  in  time  a  private  practitioner  simply 
should  not  be  in  the  business.  He  should  not  be  in  the  business  of 
methadone  maintenance.  My  feeling  is  that  I  have  never  seen  a  prac- 
tioner  in  the  metropolitan  area  of  Washington  who  I  feel  has  the 
pi'opcr  supportive  services  to  go  along  with  his  program  so  that  he 
is  an  effective  rehabilitation  mode.  I  think  that  with  the  average  physi- 
cian we  have  run  into  in  the  metropolitan  area  of  Washington,  all  he 
is  is  another  drug  seller.  I  would  hate  to  think  that  organized  crime 
ever  wants  to  move  in  under  the  guise  of  a  medical  license.  Organized 
crime  might  move  into  the  dispensing  of  methadone,  because  it  is  a 
high-profit  drug  as  it  is  being  dispensed  privately. 

Mr.  Perito.  You  presently  have  operating  in  Fairfax  County  thera- 
peutic communities  ? 

Mr.  HoRAN.  Yes ;  we  do. 

Mr.  Perito.  I  assume  by  that  you  mean  a  drug-free  community  ? 

Mr.  HoRAX.  Yes. 

Mr.  Perito.  And  they  only  use  methadone  as  a  detoxification  drug? 

Mr.  HoRAN.  Actually  the  treatment  center,  itself,  does  not  use  metha- 
done at  all  in  treatment.  We  use  methadone  in  the  jail  facilities  as  a 
withdrawal  drug  to  detoxify  an  addict. 

Mr.  Perito.  How  long  has  the  therapeutic  facility  been  in  operation 
in  Fairfax  County  ? 

Mr.  HoRAiSr.  Since  September  of  1969. 

Mr.  Perito.  Do  you  have  any  statistics  from  that  facility  as  to  the 
efficacy  of  their  approach  insofar  as  the  reduction  of  crime  or  incidence 
of  antisocial  behavior  is  concerned  ? 

Mr.  HoRAN.  I  don't  have  any  specific  statistics  that  could  prove  it 
one  way  or  the  other.  I  do  know  that  of  those  in  the  treatment  pro- 
gram wc  have  had  very  few  that  we  later  see  in  the  court  scene  as  a 
criminal  statistic. 

Ml-.  Perito.  Do  you  know,  as  a  genei-al  matter,  whether  therapeutic 
communities  have  been  successful  in  reducing  the  crime  rate  of  addicts 
under  treatment  ? 
Mr.  Horan.  I  think  probably  they  have  been. 


261 

Mr.  Perito.  Is  your  thinking  based  upon  studies  that  you  have 
seen? 

Mr.  HoRAN.  Mostly  the  reading  that  I  have  done  in  the  area,  from 
other  parts  of  the  country. 

Mr.  Perito.  If  you  have  any  of  those  studies,  I  would  appreciate 
you  making  them  available  to  the  chairman  of  the  committee. 
Mr.  IIORAX.  I  certainly  will. 

(As  of  the  time  of  printing  of  this  record,  the  committee  had  not 
received  the  studies  or  statistical  evaluations  from  Mr.  Horan  of  the 
efRcacy  of  drug-free  clinics  insofar  as  the  reduction  of  crime  or  anti- 
social behavior  is  concerned. ) 
Mr.  Pepper.  Mr.  Blommer. 

Mr.  Blommer.  Mr.  Horan,  would  you  say  that  in  Fairfax  County 
(here  are  very  many  drug  takers  that  you  would  call  addicts,  as  op- 
posed to  drug  experimenters  or  drug  users  ? 

Mr.  Horan.  The  head  of  ou]-  Fairfax-Falls  Church  Mental  Health 
Center,  a  psychiatrist,  refers  to  our  population  of  drug  abusers  as 
1)eing  garbage  collectors.  By  that  he  means  they  will  take  anything, 
regardless  of  what  it  is,  or  what  form  it  is  in. 

I  would  suspect  an  overwhelming  percentage  of  our  kids  are  in 
that  boat.  They  will  use  anything.  They  aren't  committed  strongly 
to  any  one  drug,  by  and  large. 

We  tried  to  figure  out  the  other  day,  sitting  down,  tried  to  put 
together  a  list  of  those  we  thought  were  anyv>^here  near  4  years  in 
the  vein,  and  we  couldn't  come  up  with  10,  and  most  of  them  were 
addicts  that  we  had  dealt  with,  7,  8  years  ago,  coming  out  of  the  city 
of  Alexandria,  mostly.  They  are  the  only  ones  we  could  come  up  with. 
Most  of  our  kids  are  diversified  drug  users.  They  have  tried  heroin 
a  few  times  here  and  there,  along  with  a  number  of  other  things,  and 
they  aren't  in  the  vein  that  heavily. 

As  a  matter  of  fact,  I  can  recall  no  case  of  a  jail  prisoner  who 
took  much  longer  than  20  hours  to  be  completely  detoxified.  Most 
show  absolutely  no  withdrawal  symptoms  after  the  20-hour  mark. 

As  a  matter  of  fact,  we  have  had  kids  come  in,  who  supposedly 
had  big  drug  habits,  who  never  show  any  withdrawal  symptoms  the 
whole  time  they  were  in  the  jail. 

Mr.  Blommer.  Mr.  Horan,  do  you  have  what  you  would  call  a  black 
market  in  drugs  in  Fairfax  County  and  if  so,  what  drugs  are  available. 
Mr.  Horan.  I  think  they  are  all  available,  unfortunately.  I  think 
our  drugs  essentially  come  from  about  three  major  sources. 

First,  I  would  be  in  the  hard  narcotics  field,  heroin  and  maybe  some 
morpliine  on  rare  occasions.  That  almost  invariably  is  coming  out  of 
the  wholesalers  in  the  District  of  Columbia.  I  know  of  only  one  whole- 
saler that  we  have  ever  dealt  with  in  Fairfax  County  in  the  heroin 
area.  That  is  one  source. 

The  second  source  is  the  methadone  source  which  appears  to  be 
private  practitioners  in  the  District. 

The  third  source  is  the  ximerican  free  enterprise  system  at  its  best, 
and  that  has  to  do  with  marihauna,  LSD,  and  hashish,  and  there  it  is 
a  very  amateur,  nonprofessional,  somewhat  noncommercial  market 
where  kids  are  using  a  tremendous  amount  of  ingenuity  to  come  up 
with  drugs. 


262 

A  a'reat  case  in  point  was  a  conple  of  years  airo  I  had  a  phone  call 
from  th<?  ]>r;)secutor  in  Lincoln  County,  >7ebr.,  Foit  PJafte,  Kebr.  Pie 
wanted  to  know  if  we  had  a  kid  in  our  coinmunit}',  for  want  of  a  better 
name,  Joe  Blow,  and  I  said  yes,  we  did.  As  a  matter  of  fact,  we  were 
prc^eciitinir  him  for  a  drn^  oifense  at  that  time.  They  had  just  picked 
him  up  in  ISTebraska  with  liis  trusty  sickle  in  hand,  he  was  cuttinj^ 
down  a  field  of  marilmuna  in  Lincoln  County,  Xebr.,  and  had  17- 
pouuds  in  the  trunk  of  his  car  when  the  Lincoln  County,  Nebr.,  police 
arr-psted  him. 

H?  is  th.e  free  enterpri'-e  type  who  would  come  back  with  a  tremen- 
dou'^  amount  of  marihauna  for  sale. 

Ml-.  Blommer.  You  liave  said  tliat  you  find  that  methadone  in  your 
black  market  comes  from  physicians  in  the  District  of  Columbia  that 
are  jirescribinjT;  it.  Are  there  any  physicians  in  Fairfax  County  that 
are  prescribing  methadone  that  you  feel  is  entering  in  that  black 
ma  rket  ? 

Ml".  HoRAisr.  No;  we  can't  show  any  physician  in  northern  Virginia 
add'ug  to  the  black  market.  We  have  a  couple  of  cases  that  involve 
aboi!^  eiirht  persons  who  are  receivino;  metliadone  maintenance  from 
Virginia  physicians,  but  we  find  no  indication  of  diversion. 

Mr.  Blommer.  If  you  found  a  doctor  in  your  county  that  you  felt 
was  more  of  a  peddler  than  a  healer,  is  there  any  statute  in  the  State 
of  V'  rcinia  that  you  could  use  to  prosecute  that  doctor  ? 

Ml-.  IToRAN.  Yes;  I  think  we  could  prosecute  him  under  our  Drug 
Coutrol  Act. 

Mr.  Bf  o^FMER.  You  have  heard  Dr.  JafTe  refer  to  his  law.  Then  the 
Stat.'^  of  Virginia  has  a  comparable  law? 

M:-.  HoRAN.  It  is  comparable  law.  In  my  opinion  as  a  prosecutor  it 
would  be  very,  very  difficult  to  get  a  conviction  because  I  think  you 
run  into  the  basic  ]>i-oblem  that  tlie  physician  sitting  there  before  a 
jury,  he  can  lay  it  all  off  on  the  medical  considerations,  I  made  a  medi- 
cal judgment  and  this  w^as  my  mode  of  treatment. 

I  think  you  would  have  trouble  convicting  him  imder  the  statute. 

I  think,  in  Virginia,  a  far  better  vehicle  would  be  to  go  through 
the  State  board  of  medical  examiners  to  revoke  his  license,  or  in  the 
case  of  pharmacists,  the  State  board  of  pharmacy  to  revoke  his  license. 
I  think  that  would  be  a  far  better  method  of  getting  at  the  corrupt 
practitioners  than  would  be  a  criminal  prosecution  under  the  Drug 
Control  Act. 

Mr.  Blommer.  Would  you  favor  Federal  legislation  in  this  area? 

Mr.  HoRAN.  I  am  totally  in  favor  of  Federal  legislation  that  sets 
up  strict  controls  on  methadone  availability.  One  of  the  reasons  I  feel 
so  strongly  about  it  is  that  I  know  that  for  a  year  we  banged  our 
heads  against  a  brick  wall  to  try  to  cut  down  the  availability  of  this 
drug  that  was  coming  out  of  the  District  of  Columbia. 

We  have  been  totally  unsuccessful.  We  have  got  three  deaths  to 
prove  it.  It  seems  to  me  only  Federal  legislation  is  going  to  control 
that  situation,  at  least  as  far  as  Virginia  is  concerned. 

Mr.  Blommer.  Thank  you,  JVIr.  Horan, 

That  is  all  the  questions  I  have,  Mr.  Chairman. 

Chairman  I^epper.  Mr.  Mann  ? 

Mr.  ]Mann.  No  questions. 


263 

Chairman  Pepper.  Mr.  Steiger  ? 

Mr.  Steiger.  Thank  you,  jMr.  Chairman. 

Mr.  Horan,  to  your  knowledge,  has  any  physician  ever  been  charged 
in  the  State  of  Virginia  under  the  statute  to  which  you  just  referred? 

Mr.  HoRAx.  Yes ;  I  think  there  have  been  charges  under  that  statute. 

Mr.  Steiger.  To  what  degree  of  success  ? 

IMr.  HoRAX.  The  net  effect  was  that  the  physician  just  turned  in  his 
license  and  the  prosecution  ended  there.  They  didn't  pursue  it. 

IMr.  Steiger.  He  didn't  continue  the  practice  of  medicine? 

Mr.  HoRAx.  He  lost  his  right  to  practice  medicine. 

Mr.  Steiger.  You  mentioned  in  several  instances  of  private  physi- 
cians in  the  District  of  Columbia  who  are  the  source  of  diverted 
methadone.  How  many  are  we  talking  about  ? 

Mr.  HoRAX.  At  least  four. 

Mr.  Steiger.  At  least  four. 

And  you  know  who  they  are  ? 

Mr.  HoRAX.  Yes ;  I  think  we  have  a  good  idea. 

Mr.  Steiger.  What  kind  of  volume  are  we  talking  about.  I  ^uess  the 
thing  that  would  really  interest  us  would  be  not  only  that  which  finds 
its  way  into  Fairfax,  but  that  which  is  being  diverted  in  the  District, 
also. 

Mr.  HoRAx.  One  example  that  I  can  give  you  is  in  the  case  of  one 
specific  physician.  We  have  had  him  under  surveillance  a  number 
of  times  over  in  the  District  because  we  feel  that  at  least  two  of  the 
drug  deaths  we  have  are  related  to  his  supply. 

In  the  course  of  surveillance  of  this  physician  there  was  never  a 
time  when  the  physician  had  less  than  10  patients  an  hour  in  his  office 
at  $15  a  throw.  If  you  give  him  a  six-hour  day  and  a  5-day  week,  he 
has  about  $325,000  gross  minimum  in  just  his  dispensing  habits. 

Mr.  Steiger.  Excuse  me.  All  of  these  patients,  based  on  your  observ- 
ance, were  receiving  methadone  ? 

Mr.  HoKAX.  Yes ;  everybody  that  was  in  there.  That  is  what  he  is 
there  for. 

Mr.  Steiger.  He  didn't  do  much  else  ? 

Mr.  HoRAX.  He  is  supposedly  a  general  practitioner,  but  I  think 
his  main  business  is  methadone.  In  his  case,  he  is  dispensing  in  a  form 
that  is  probably  costing  him  $0.25.  In  my  opinion,  the  whole  treatment, 
at  least  as  we  know  it,  has  to  do  with  dispensing  methadone  and 
nothing  more. 

Mr.  Steiger.  Right. 

Mr.  HoRAx.  There  are  no  rehabilitative  or  vocational  services. 

Mr.  Steiger.  Do  you  know  the  form,  the  physical  form  ? 

Mr.  HoRAx.  Methadone  mixed  in  Tang. 

Mr.  Steiger.  It  was  the  same  form  in  which  it  is  given  at  the  clinic 
as  you  described  ? 

Mr.  HoRAX.  That  is  right. 

Mr.  Sreiger.  It  has  been  your  experience,  which  you  stated  in  your 
statement,  that  contrary  to  some  of  the  medical  opinion  we  had  that  at 
least  one  victim  apparently  did  shoot  the  mixture  in  the  Tang  ? 
Mr.  HoRAX.  Every  one  of  our  dead  ones  was  in  the  vein  with  metha- 
done; in  one  case  it  was  the  methadone  mixed  in  Tang.  Every  one 
of  them  was  shooting  but  only  one  of  them,  to  my  knowledge,  had 
Tang. 


264 

Mr.  Steiger.  Did  you  discuss  with  the  District  of  Columbia  author- 
ities this  particular  physician  ? 

Mr.  HoRAN.  Yes ;  I  did. 

Mr.  Steiger.  Did  they  corroborate  your  observance? 

Mr.  HoRAx.  As  a  matter  of  fact,  the  District  of  Columbia  Police 
indicated  to  me  that  on  four  occasions  they  had  detectives  who  went 
to  this  doctor's  office  and  got  methadone. 

Mr.  Steiger.  Do  you  know  what  action  they  took  against  him  ? 

Mr.  IIoran.  There  was  a  grand  jury  proceeding,  and  the  grand  jury 
did  not  indict.  I  am  only  basing  this  on  hearsay,  as  to  what  the  grand 
jury  proceeding  was.  There  has  never  been  a  prosecution  for  illegal 
dispensing  against  that  physician. 

Mr.  Steiger.  Is  there  an  AMA  organization  in  the  District? 

Mr.  HoRAN.  I  believe  there  is. 

Mr.  Steiger.  Do  you  know  if  anybody  has  called  this  matter  to  their 
attention  ? 

Mr.  IIoiLVx.  I  think  it  has  been.  I  think  it  has  been  brought  to  the 
attention  of  the  D.C.  Medical  Society. 

Mr.  Steiger.  As  far  as  you  know — this  fellow — there  was  no  action 
taken  to  limit  this  activity  ? 

Mr.  HoRAN.  No ;  there  was  not. 

Mr.  Steiger.  Now,  these  other  three  that  you  are  aware  of,  are  they 
conducting  as  extensive  an  operation  as  this  gentleman? 

Mr.  HoRAN.  One  of  them  may  be  bigger. 

Mr.  Steiger.  Is  it  possible  that  there  are  other  physicians  that  you 
aren't  aware  of? 

Mr.  HoRAN.  Oh,  yes;  I  am  sure  of  that.  "What  happens  to  you.  I 
think,  is  that  certain  physicians  develop  a  name  in  drug  circles,  that 
name  is  mentioned,  and  it  is  kind  of  a  public  relations  program  to  be- 
come known  and  then  you  become  the  source. 

I  think  that  is  what  happens.  Maybe  the  kids  in  ^Montgomery 
County  are  going  to  someone  else;  I  don't  know. 

]Mr.  Steiger.  Have  you  ever  checked  with  the  FDA  to  find  out  if 
any  of  these  four  have  a  so-called  IND  number  issued  by  the  FDA  ? 

Mr.  HoRAN.  I  have  checked  with  them  on  two  of  them  and  they  do. 

Mr.  Steiger.  They  do  ? 

Mr.  HoRAN.  Two  of  them  do. 

Mr.  Steiger.  What  was  the  response  of  the  FDA  when  you  advised 
them  of  your  observance  ? 

Mr.  HoRAN.  We  never  had  an  awful  lot  of  success  with  FDA.  I 
guess  we  had  about  as  much  success  as  the  Bureau  of  Narcotics  and 
Dangerous  Drugs.  There  seem  to  be  some  loggerheads  between  the  two 
of  them  as  to  what  the  policy  should  be.  I  final Iv  brought  it  to  the 
attention  of  Virginia's  two  U.S.  Senators  and  "at  least,  based  on 
the  speech  that  Senator  Byrd  gave  on  the  floor  of  the  Senate,  he  didn't 
have  an  awful  lot  of  success  with  FDA,  either. 

Mr.  Steiger.  I  think  loggerheads  is  a  very  general  philosophy. 

I  take  it,  then,  as  recited  both  bv  the  chairman  and  INTr.  ^Nlann.'and  T 
guess  everybody  else,  that  you  do  favor  very  specific  Fodornl  statutes 
which  obviously  would  be  applicable  in  the  District  of  Columbia « 

Mr.  HoRAN.  Yes,  sir ;  I  do. 


265 

Mr.  Steiger.  Limiting  the  dispensing  of  methadone  ? 

Mr.  HoRAN.  At  this  time  I  don't  think  private  practitioners  should 
be  in  the  business. 

Mr.  Steiger.  Based  on  your  testimony,  at  an  estimated  cost  of  25 
cents,  this  man  is  making  a  profit  of  $14.75  a  patient,  less  the  overhead 
for  rent  and  lights  and  heat,  and  at  the  rate  of  10  patients  an  hour, 
he  is  there  for  somewhere  in  the  neighborhood  of  $150  an  hour  ? 

Mr.  HoRAN.  At  least. 

Mr.  Steiger.  Mr.  Chairman,  I  won't  pursue  this  any  further,  but  I 
would  like  to  compliment  the  staff  and  Mr.  Horan  for  spelling  this  out 
so  specifically.  I  think  one  of  our  basic  problems  has  always  been  the 
tendency  to  accept  the  medical  profession  as  being  incapable  of  the 
kind  of  action  you  described,  and  I,  for  one,  have  never  subscribed  to 
that,  the  sanctity  of  any  profession.  They  are  just  people,  and  I  would 
hope  that  we  would  be  able  to  do  something,  Mr.  Chairman. 

Chairman  Pepper.  I  am  sure  the  committee  will  give  very  serious 
consideration  to  that  problem. 

Mr.  Horan.  I  would  suggest,  Mr.  Chairman,  if  I  might,  I  think  one 
of  the  difficulties  that  you  run  into  is  that  by  and  large  medicine  as  a 
group  has  never  paid  much  attention  to  this  subject  because  it  was  just 
beyond  normal  medical  needs.  I  think  what  has  happened  is  that  you 
do  have  a  very  small  percentage  in  the  clinical  end,  and  of  course  they 
are  some  of  the  great  minds  on  the  subject,  Jaffe,  Wyland.  and  Dole. 
Those  are  the  people  who  have  the  most  experience  with  it.  Medicine 
generally  has  never  dealt  with  it. 

It  is  not  taught  in  medical  schools.  When  the  private  practitioner 
gets  into  this  business  he  is  dealing  with  a  very  difficult  situation  be- 
cause he  is  not  really  in  a  knowledgeable  position. 

Chairman  Pepper.  If  I  may  corroborate  what  you  said,  my  wife  and 
I  have  been  identified  for  a  long  time  with  the  Parkinson  Foundation 
and  Institute,  and  we  have  come  in  contact  with  some  of  the  outstand- 
ing authorities  who  have  developed  and  discovered  methods  for  the 
practical  application  of  L-Dopa  in  the  treatment  of  Parkinson's  dis- 
ease, and  these  authorities  say  very  strongly  that  the  average  practi- 
tioners should  not  be  permitted  to  give  L-Dopa  because  they  don't 
know  that  much  about  it. 

I  know  a  Senator  here  in  the  Congress  right  now  who  was  being 
given,  by  certain  medical  authorities,  large  quantities  of  L-Dopa.  One 
of  the  outstanding  authorities  in  the  country  visited  the  Senator  and 
reduced  his  dosage  very  much  and  he  improved,  because  it  is  a  spe- 
cialized subject  and  you  have  to  know  a  lot  about  it  before  you  can 
wisely  dispense  it. 

JNIr.  HoRAN.  Yes,  sir. 

Chairman  Pepper.  Have  you  finished  ? 

Mr.  Steiger.  Yes,  sir. 

Chairman  Pepper.  Mr.  Rangel. 

Mr.  Rangel.  Yes. 

Mr.  Horan,  you  support  the  efforts  being  made  b}^  the  District  of 
Columbia  and  New  York  City  in  the  area  of  treating  addicts  with  the 
use  of  methadone  ? 

Mr.  Horan.  Yes ;  in  a  certain  class  of  cases. 

]Mr,  Rangel.  And  you  also  support  its  use  in  the  jails  of  Fairfax 
County  ? 

60-296— 71— pt.  1 18 


266 

Mr.  HoRAN.  We  don't  support  it  as  a  matter  of  maintenance,  only  as 
a  matter  of  withdrawal. 
Mr.  Kangel.  For  detoxification  ? 

Mr.  HoRAN.  Right ;  bring  them  down,  and  we  bring  them  down  in- 
side of  48  hours. 

Mr.  Rangel.  What  is  the  ethnic  composition  of  the  drug  addicts  in 
Fairfax  County? 

Mr.  HoRAN.  That  is  a  good  question.  INIy  county  is  about  5  percent 
black.  Using  the  normal  phrase  "minority  group,"  I  don't  think  there 
is  a  high  percentage  of  any  other  minority  group  in  my  county.  Yet 
in  the  year  1970,  of  322  prosecutions  only  10  of  the  322  were  blacks. 
In  our  black  community,  by  and  large,  we  never  really  had  a  drug 
problem  until  the  fall  of  last  year  when  one  major  dealer — and  this  is 
the  only  real  wholesaler  I  have  ever  dealt  with  in  the  heroin  field — 
moved  into  our  black  community,  began  a  selling  operation,  and  un- 
fortunately about  the  time  we  got  into  the  act  there  were  a  number  of 
15-  and  16-year-old  blacks  in  the  vein,  pretty  serious  heroin  habits. 

Of  course,  Ave  never  would  have  cracked  it,  except  for  a  District  of 
Columbia  policeman.  He  is  really  the  one  who  cracked  it  for  us. 

Mr.  Raxgel.  So  your  overwhelming  population  in  Fairfax  County 
is  white  ? 

Mr.  HoRAN.  That  is  right. 

Mr.  Rangel.  If  you  had  to  give  a  general  classification,  what  would 
they  be,  middle  income  ? 

Mr.  HoRA>r.  High-middle  income.  In  median  income  we  are  about 
the  third  or  fourth  county  in  the  count r3%  I  think. 

Mr.  Rangel.  Were  you  here  earlier  when  I  asked  Dr.  Jaffe  whether 
he  thought  that  the  medical  profession  had  established  a  different 
standard  in  taking  care  of  the  problems,  medical  problems  of  poor  peo- 
ple as  opposed  to  the  medical  problems  of  middle  income  people  ? 
Mr.  HoRAN.  Yes;  I  heard  that  question,  and  I  thought  about  that. 
Mr.  Rangel.  Aren't  you  really  supporting  that  type  of  thing  in 
your  testimony  today  ? 

Mr.  HoRAN.  No.  I  feel  this  wa^-,  and  I  feel  pretty  strongly  about  it : 
You  look  at  the  statistics,  the  statistics  still  indicate  that  one-half  of 
all  heroin  addicts  in  the  country  live  in  the  city  of  New  York.  Of  those 
in  the  city  of  New  York,  let's  face  it,  most  of  tliem  come  from  Harlem 
or  Spanish  Harlem.  As  long  as  there  Avas  a  problem  in  the  city  of  New 
York  in  those  communities,  nobody  really  cared,  who  cared  outside  the 
city  authorities  ? 

The  rest  of  the  countrs^  didn't  worry  about  it,  it  wasn't  their  prob- 
lem. I  think,  by  and  large,  because  it  was  the  low-income  groups  in  the 
city  of  New  York,  no  one  cared. 

That  is  a  tragedy.  I  think  we  should  have  been  learning  something 
from  New  York's  30  years  of  experience  and  we  didn't. 

On  the  other  hand,  I  think  that  medicine  by  and  large  now  sees  it 
on  a  large  scale,  all  over  the  country.  ]\Iedicine  is  looking  at  it,  and 
I  think  medicine,  like  everybody  else,  is  scrambling  for  an  answer.  I 
would  not  impute  to  medicine  the  motive  that  they  are  willing  to  take 
the  easy  way  out  and  just  consign  these  low-income  groups  to 
addiction. 

Mr.  Rangel.  Let's  look  at  it  in  view  of  your  testimony.  What  you 
are  basically  saying  is  that  you  would  like 'to  see  medical  science  pro- 


267 

vide  otlier  ways  to  take  care  of  your  addict  population  rather  than 
relying  on  methadone  'i 

Mr.  HoRAN.  Yes ;  I  would. 

Mr.  Raj^-gel.  And  you  also  say  if  the  situation  gets  so  bad  in  your 
community  that  there  is  no  way  out  except  methadone,  then,  and 
only  then,  will  you  consider  this  ? 

Mr.  HoRAx.  Absolutely. 

Mr.  Rangel.  I  am  asking  you,  would  you  not  give  the  sam.e  con- 
sideration to  the  District  of  Columbia  and  the  population  of  New 
York  City,  that  is,  until  you  can  evaluate  that  our  addict  population 
has  reached  that  point  then  you  would  have  this  same  reservation  about 
the  distribution  of  methadone  for  any  community  ? 

Mr.  HoRAx.  I  sure  would. 

Mr.  Rangel.  I  am  only  hoping  that  the  medical  profession  will 
share  your  ideas. 

Mr.  H0R.VX.  Of  course,  Mr,  Rangel,  my  difficulty  is  in  evaluating 
New  York.  I,  necessarily,  have  to  rely  on  what  Dr.  Dole  is  saying, 
Dr.  Gollance  is  saying,  what  New  Yorli's  experts  are  saying  about  their 
population,  and  they  tell  me  in  their  writings  that  what  they  are 
essentially  aiming  at  is  the  guy  who  has  been  in  the  vein  for  many, 
many  years,  the  guy  who  is  just  fully,  totally,  and  completely  hooked 
on  heroin. 

They  are  saying  to  me  the  only  way  we  can  treat  them  is  with  meth- 
adone. My  answer  is,  I  don't  know. 

But  I  do  know  this,  that  I  don't  think  methadone  is  the  answer 
if  you  have  got  a  guy  only  2  years  in  the  vein  and  if  they  are  com- 
mitting New  York  addicts  with  2  years  in  the  vein  to  methadone, 
I  think  they  are  wrong. 

I  think  they  should  be  going  some  other  route  of  treatment, 

]\Ir.  Raxgel.  So  if  my  breed  of  addict,  or  a  part  of  my  breed  of 
addict,  is  similar  to  what  you  described  as  similar  to  Fairfax  County's 
breed  of  addict,  we  would  share  the  same  ideas  ? 

Mr.  lioRAx.  Yes ;  I  don't  think  the  addict,  the  IT-,  18-,  19-year  old, 
I  don't  think  he  should  be  committed  to  a  methadone  mamtenance 
program  at  that  age  or  with  that  short  a  term  of  addiction.  When  I 
ttilk  of  breed  of  addict,  really  what  I  am  talking  about  is  in  New 
York  where  you  have  a  lot  of  people  who  have  been  in  the  vein  10 
years,  I  don't  have  any  of  those.  But  I  think  that  those  that  are  in 
the  same  position  as  mine,  the  18-year  old  who  has  been  in  the  vein 
for  a  year,  I  don't  agree  with  New  York  putting  him  on  methadone 
any  more  than  I  agree  with  Fairfax  County  putting  him  on 
methadone. 

Mr.  Raxgel.  Mr.  Chairman,  I  want  to  join  in  with  my  colleagues 
and  thank  the  staff  for  bringing  Mr.  Horan  before  us.  I  think  it  sub- 
stantiates the  fact  that  not  everyone  has  just  accepted  methadone  as 
a  solution  to  our  present  problem. 

Thank  you,  Mr.  Horan. 

Chairman  Pepper.  We  all  will  profit  very  much  from  your  testi- 
mony. 

We  have  some  more  questions. 

Mr.  Winn. 

Mr.  Wixx.  Thank  you,  Mr.  Chairman. 


268 

Mr.  Horan,  let's  back  up  a  little  bit.  Over  in  Fairfax  County,  those 
that  are  on  drugs,  the  kids  that  are  on  drugs,  a  high  percentage  of 
the  users  are  on  marihuana ;  right  ? 

Mr.  HoRAx.  Well,  a  less  high  percentage  all  the  time.  In  1967  one 
case  out  of  every  10  would  be  a  stronger  drug  than  marihuana.  By 
last  year  it  was  one  case  out  of  every  four.  I  think  there  has  been  a 
real  graduation  of  marihuana  users. 

Mr.  Winn.  The  percentage  of  those  who  were  on  marihuana  have 
switched  and  gone  to  the  harder  drugs  in  the  percentage  of  one  out 
of  four  now ;  right  ? 

Mr.  HoRAN.  Yes. 

Mr.  Winn.  All  right.  Physicians  prescribe  all  kinds  of  drugs  for 
different  things,  which  is  within  their  realm.  It  is  a  little  hard  for 
me  to  comprehend  that  all  the  bad  guys  are  in  the  District  of  Columbia, 
physicianwise,  and  all  the  good  guys  are  in  Fairfax  County. 

Mr.  Horan.  I  wouldn't  want  to  create  that  impression  although, 
you  know 

Mr.  Winn.  I  think  maybe  we  have. 

Mr.  Horan.  In  fairness  to  our  medical  society,  I  would  say  abso- 
lutely that  one  of  our  real  sources  of  help  out  there  has  been  the  medi- 
cal profession.  I  think  they  police  themselves. 

Mr.  Winn.  That  leads  me  into  the  next  question :  Do  you  think  it 
is  because  of  the  strength  of  the  Fairfax  County  medical  society  that 
they  are  keeping  a  stronger  and  tighter  rein  on  the  doctors  and  physi- 
cians over  there  that  might  be  prescribing,  say  free  lancing,  methadone 
compared  to  the  District  of  Columbia  ? 

Mr.  HoRAN.  Yes,  sir.  I  think  that  is  probably  part  of  it.  I  think 
another  ])art  of  it  is  the  fact  that  when  the  drug  phenomena  hit  us  in 
1966,  medicine  got  in  the  act  early,  and  medicine  began  taking  a  look 
at  this  subject  that  they  knew  nothing  about. 

Let's  face  it,  the  average  physician,  if  he  is  below  age  25,  he  never 
had  a  course  in  medical  school  that  involved  the  three  main  abuse 
drugs  in  society  today,  LSD,  marihauna,  and  heroin.  They  aren't 
taught  in  medical  school  because  they  have  no  therapeutic  value. 

Mr.  Winn.  They  are  still  not  being  taught  now  ? 

Mr.  Horan.  Well,  Georgetown 

Mr.  Winn.  But  not  nationwide  ? 

Mr.  Horan.  No  ;  it  is  not. 

So  medicine,  first  of  all,  in  a  community  such  as  mine,  has  got  to 
get  into  the  act  to  understand  it  to  begin  with,  because  they  are  in  a 
foreiirii  field,  just  like  every  layman  out  on  the  street. 

Our  medical  society  did  that.  Our  medical  society  took  a  good  hard 
look  at  prescribing  practices,  which  I  think  is  really  the  key. 

I  think  medicine  has  got  to  look  at  themselves  and  say  what  are  we 
doing. 

Mr.  Winn.  Right.  That  clarifies  that,  because  I  don't  think  you 
really  made  that  clear,  at  least  I  didn't  get  it  that  way  in  the  earlier 
testimony. 

Now,  the  Drug  Control  Act  is  basically  controlled  again  by  each 
State.  That  would  go  right  along  with  the  same  vein  of  thinking, 
depending  on  which  State  is  really  going  to  clamp  down  and  wliich 
ones  are  going  to  close  their  eyes  to  some  of  the  acts ;  right  ? 


269 

Mr.  HoRAN.  That  is  right. 

Mr.  Winn.  Which  would  come  into  effect  possibly  again  because 
of  the  control  and  the  District  of  Columbia  control  might  be  lighter 
than  in  Virginia. 

Mr.  HoRAN.  I  think  that  is  right. 

Mr.  Winn.  Okay. 

Well,  I  don't  know  about  Baltimore — how  about  Baltimore? 

Mr.  HoiLVN.  I  never  had  all  that  much  experience  with  Baltimore. 

Mr. _  Winn.  All  right.  You  mentioned  several  times  the  history  of 
the  jail  cases,  and  I  understood  you  to  say  that  you  have  a  system,  I 
believe  you  referred  to  some  hours  and  you  said  24  hours  as  an  aver- 
age for  getting  them  detoxified  ? 

Mr.  HoRAN.  Most  of  the  time,  they  are  detoxified  in  24  hours. 

Mr.  Winn.  Twenty-four  hours  ? 

Mr.  HoRAN.  That  is  without  any 

Mr.  Winn.  Yes ;  right. 

Mr.  HoRAN.  "\^^ierever  it  is  felt  that  they  need  help  to  come  down, 
it  is  all  over  in  48  hours. 

Mr.  WixN.  Then  you  use  methadone ;  right? 

Mr.  HoRAN.  Jail  physicians  prescribe  Dolophine  in  a  certain  amount 
and  that  is  what  the  prisoner  gets  and  it  never  goes  over  48  hours. 

Mr.  Winn.  What  is  their  reaction  to  the  methadone  within  that 
48-hour  period  ? 

Mr.  HoRAN.  It  all  depends  on  what  kind  of  addict  they  are. 

Mr.  Winn.  Give  us  the  worst  example  and  give  us — and  the  lightest 
one  obviously  would  have  no  reaction,  probably.  The  heaviest 

Mr.  HoRAN.  One  of  the  things  you  constantly  have  to  watch  for  is 
the  kid  who  comes  in  there  and  the  first  thing  he  is  saying  when  that 
jail  door  closes  is,  get  me  the  methadone,  because  the  word  is  out 
among  that  breed  that  you  can  get  this  stuff  if  you  qualify  and  you 
may  have  a  rruy  coming  in  there  that  isn't  really  any  addict  at  all,  and 
he  wants  methadone  because  he  is  going  to  get  high. 

Two  davs  in  jail  high  beats  2  days  in  jail  any  other  way.  So  he  wants 
it.  ■  ^  _ 

Mr.  Winn.  How  does  he  get  hisfh  on  oral  methadone  that  is  taken 
with  Tang? 

Mr.  HoRAN.  Anybody  who  says  you  don't  get  a  high  on  methadone 
is  dreaming.  I  am  talking  about  you  and  I.  The  problem  is — and  I  see 
the  newspapers  constantly  use  this  term — a  "noneuphoric  substitute 
for  heroin" — it  is  not  a  noneuphoric  substitute. 

If  you  are  talking  about  a  guy  who  has  been  in  the  vein  5  years, 
yes;  but  you  know,  you  could  do  anything  to  that  guy  and  it  is  going 
to  be  noneuphoric  compared  to  heroin.  With  most  other  people  we 
get  a  high. 

Many  women  today  in  hospitals  after  a  very  difficult  delivery,  the 
prime  druff  used  the  following  day  after  the  delivery,  if  the  woman 
is  in  pain  and  having  problems,  is  what  they  call  in  the  hospital  Dolo- 
phine, and  that  is  methadone,  same  drug.  They  give  her  Dolophine. 

You  talk  to  anv  woman  who  has  ever  hpd  Dolophine  and  ask  her  if 
it  is  euphoric.  She  says,  "You  bet  your  life.  That  is  the  reason  they 
gave  it  to  me.  it  lifted  my  spirits  and  killed  the  pain.  That  is  why 
they  gave  it  to  me."  It  does  have  a  definite  euphoria  on  the  scale. 


270 

It  is  not  up  to  heroin  or  morphine,  but  it  is  probably  on  the  level 
with  Demerol ;  anybody  who  has  ever  had  Demerol  will  agree  it  has 
a  good  euphoria. 

li  a  guy  comes  into  jail  and  is  really  not  an  addict,  he  is  going  to 
get  a  high. 

Mr.  Winn.  Wait  just  a  minute.  I  want  to  point  out  strongly,  Mr. 
Chairman,  that  this  is  in  direct  conflict  with  testimony  we  have  heard 
in  the  past  from  several  of  these  other  experts.  I  want  to  point  it  out 
because  it  is  completely  different. 

Chairman  Pepper.  Apropos  of  what  my  colleague  said,  the  way  I 
believe  it  was  stated  by  Dr.  Jaife  this  morning  was  that  with  the  first 
little  bit  of  taking  of  methadone  you  do  get  a  high,  but  then  if  the  doc- 
tor giving  it  keeps  on  experimenting  with  the  individual  and  gets  to  a 
point  where  that  person  is  stabilized  and  he  doesn't  get  a  high, 

Wasn'tthat  the  gist? 

Mr.  Winn.  I  believe  that  was  Dr.  Jaffe's  ptatem.ent,  Mr.  Chairman, 
but  I  believe  one  of  the  other  experts  said  that  there  was  no  euphoric 
sensation  from  orally  taken  methadone. 

Mr.  HoRAN.  I  say  that  is  flat  out  untrue. 

I  think  the  problem  is  that  they  are  constantly  asking  a  true  addict 
is  there  any  euphoria,  and  he  is  telling  the  truth,  for  him  there  is 
none,  but  he  is  comparing  it  to  heroin.  It  is  like  the  Irishman  and  the 
Englishman  seeing  the  guy  la3'ing  in  the  ditch.  The  Englishman  said, 
"Look,  that  guy  is  drunk."  The  Irishman  said,  "No,  he  isn't,  he 
moved." 

It  is  about  the  same  ball  park,  really. 

There  is  medical  research  that  will  substantiate  the  fact  tliat  if 
you  get  to  a  certain  level  of  heroin  use,  say  the  guy  who  is  maybe  a 
hundred  dollars  a  day  in  the  vein,  he  gets  to  a  certain  level  where  the 
heroin  itself  is  noneuphoric  because  he  has  gotten  too  high  on  the 
scale,  there  is  no  euphoria  left  in  the  drug  for  him. 

In  fact,  there  are  some  in  research  who  sav  you  could  create  the 
same  blockage  M-ith  high  doses  of  heroin  as  you  do  with  high  doses 
of  methadone,  because  you  reach  the  point  where  the  drug  itself 
reaches  the  block. 

Mr.  Winn,  Let  me  ask  you  one  more  question. 

Of  the  drug  deaths  that  you  referred  to,  could  the  drug  deaths  be 
from  an  overdose  of  oral  methadone  ? 

Mr,  HoRAN.  That  is  a  very  good  question.  In  two  of  the  cases  it 
appears  that  the  dead  boy  was  taking  it  both  orally  and  intravenously. 
It  could  have  been  the  combination,  although  our  pathologist 
suspects  that  because  of  the  massive  infusion  when  you  go  in  through 
the  vein,  that  is  what  causes  the  quick  respiratory  system  depression. 

Mr.  Winn.  We  have  had  some  statements  made  here  and  the  facts 
presented  to  us,  that  some  of  the  deaths  not  in  Fairfax  County,  but 
some  of  the  deaths  from  methadone  really  proved  out  to  be  not  deaths 
from  methadone  at  all,  but  a  combination  of  lots  of  other  things;  is 
that  possible  ? 

jNIr.  HoRAN.  Sure  it  is. 

Chairman  Pepper.  The  committee  has  to  go  to  the  floor  to  vote. 

We  will  take  a  brief  recess.  We  will  be  back  in  a  few  minutes. 

(A  brief  recess  was  taken.) 


271 

Chairman  Pepper.  The  committee  will  come  to  order,  please. 

Mr.  Keatinsr,  ttouIcI  you  like  to  examine  ? 

]Mr.  IvEATixG.  ^Ir.  Horan,  I  was  not  here  for  your  entire  testimony. 
However,  the  portions  that  I  heard  in  the  question  and  answer  por- 
tion of  vour  statement  I  found  to  be  excellent. 

I  think  ]Mr.  Ranp:el  had  indicated,  and  I  agfree,  that  the  goal  we  want 
to  achieve  is  rehabilitation  and  not  total  maintenance  for  the  life- 
time of  the  addict.  So  I  don't  have  any  specific  question,  but  I  wanted 
to  make  those  comments. 

Chairman  Pepper.  Thank  you. 

]Mr.  Horan,  your  testimony  about  the  drug  problem  in  Fairfax 
County  is  of  particular  interest  to  those  of  us  who  are  on  this  com- 
mittee now  who  were  members  of  the  committee  in  the  last  Congress, 
because  either  in  the  latter  part  of  1969  or  the  early  part  of  1970  we 
held  a  hearing  in  Fairfax  Countv,  vou  recall,  in  the  courthouse? 

]Mr.  HoRAxrYes,  sir :  the  fall  of  1969. 

Chairman  Pepper.  What  interested  us  was  that  here  was  a  very  fine 
county,  composed  of  very  fine  citizens,  high  level  of  income,  primarily 
residential  in  character,  that  had  a  heroin  problem. 

I  recall  very  well  that  we  had  some  students  from  one  of  your  high 
schools  who  testified  at  our  hearing  and  told  about  the  prevalence  of 
drugs  in  the  schools,  the  high  schools. 

So,  you,  as  the  Commonwealth's  attorney  of  Fairfax,  are  telling  us 
that  in  1969  the  drug  problem  in  Fairfax  County  became  serious  and 
continues  to  be,  I  imagine,  a  very  serious  problem. 

Mr.  HoRAx.  Yes,  sir ;  is  it. 

Chairman  Pepper.  Do  you  find  that  drugs,  either  in  one  way  or  an- 
other, are  related  to  the  crime  problem  in  your  county  ? 

Mr.  Horan.  Mr.  Chairman,  we  have  seen  in  the  last  2  years,  anyway, 
a  veiy  high  percentage  of  drug-related  crime.  They  aren't  actually 
coming  into  the  court  as  a  drug  case,  a  drug  prosecution,  but  in  the 
area  of  burglary  or  robbery.  We  had  two  murders  last  year  where  the 
defense  to  the  murder  was  that  it  was  committed  under  the  influence 
of  LSD.  So  we  have  seen  a  very  high  percentage  of  drug- related  crime. 

Chairman  Pepper.  So  you  are  concerned  about  the  drug  problem  in 
relationship  to  crime  primarily  as  the  Commonwealth's  attorney. 

You  have  observed,  as  a  prosecuting  attorney,  certain  reactions  to 
the  use  of  methadone  which  have  also  concerned  you  and  which  you 
have  been  very  ably  telling  us  about  here  today.  You  are  speaking,  of 
course,  out  of  your  experience  as  a  prosecuting  attorney,  not  as  a  medi- 
cal doctor,  I  assume  ? 

Mr.  HoRAN.  That  is  right. 

Chairman  Pepper.  I  suppose  we  all  agree  that  somehow  or  another 
we  must  find  a  way  of  dealing  adequately  with  the  drug  problem,  par- 
ticularly heroin  problem,  and  we  don't  want  to  create  another  problem 
in  tryinsf  to  get  rid  of  the  first, 

Mr.  HoRAX.  Exactly. 

Chairman  Pepper.  You  have  raised  a  very  serious  question  as  to 
whether  or  not  a  private  physician,  unskilled  in  respect  to  this  sub- 
stance of  methadone  and  others  of  similar  character,  should  have  au- 
tliority  to  distribute  it.  dispense  it.  There  is  always  a  possibility  of 
abuse.  We  are  very  much  concerned  about  that  very  thinp-.  We  had  "wit- 


272 

nesses  yesterday  who  brought  out  the  very  question  you  talked  about 
here  today,  the  danger  of  allowing  private  physicians  to  prescribe 
methadone  at  will. 

If  it  were  to  be  distributed  by  a  private  doctor,  would  you  consider 
it  desirable,  if  not  imperative,  that  there  be  a  registry  so  that  every 
doctor  who  did  prescribe  methadone  would  have  to  report  it  to  a  cen- 
tral force  or  data  bank  so  that  any  other  doctor  who  wanted  to  protect 
the  public  interest  would  have  easy  access  to  that  information  to  know 
what  other  doctors  were  prescribing,  maybe  in  the  same  day  for  the 
same  patient,  and  also  it  would  give  an  opportunity  for  somebody 
looking  at  that  data  bank  to  see  how  much  methadone,  for  example, 
was  being  prescribed  by  any  one  doctor,  whether  he  was  making  a  pri- 
mary business  of  that ;  would  you  favor  such  a  data  bank  ? 

Mr.  HoT^Ax.  I  would  feel  that,  if  the  private  practitioner  is  going 
to  be  in  the  business,  the  data  bank  is  absolutely  imperative.  I  think 
that  is  part  of  our  problem  here. 

Second,  I  think  ovce.  a  data  bank  was  established,  it  should  be  moni- 
tored by  someone  outside  those  who  are  in  the  business. 

Chairman  Pepper.  Well,  the  last  question  is:  Would  you  think  it 
desirable  for  the  Federal  Government  to  give  very  serious  considera- 
tion to  trying  to  find  something  better  and  less  objectionable  than  meth- 
adone in  dealing  with  this  matter  of  breaking  heroin  addiction  ? 

Mr.  HoRAN.  Yes,  I  do,  Mr.  Chairman.  INIy  concern  is  with  the  ques- 
tion of  leaving  a  drug  personality  when  you  are  finished  with  your 
methadone  program. 

It  would  seem  to  me  Federal  money  would  be  well  spent  in  th_e 
area  of  trying  to  come  up  with  a  different  tool,  a  different  ]>harma- 
cological  tool. 

As  a  criminal  prosecutor  I  sit  there  and  when  somebodv  shows  me 
reduced  crime  rates  I  have  got  to  be  impressed ;  that  means  something 
to  me.  Maybe  I  am  selfish.  Maybe  I  don't  like  as  much  business  as 
I  have. 

1  would  like  to  see  a  reduced  crime  rate.  But  I  always  have  in  mv 
mind — what  is  the  price?  You  know,  we  could  reduf^e  the  rate  of  rnnp 
by  providing  every  rapist  with  a  wom.an,  for  example,  and  you  could 
go  to  your  handy  service  clinic  and  get  a  woman  and  then  we  cut  rape 
in  half,  or  worse,  and  what  is  the  price?  I  feel  the  snme  wav  about 
methadone.  What  is  going  to  be  the  price  of  having  this  many  drug 
personalities,  and  that's  what  we  have  when  the  drug  is  out  in  socie^v. 

I  think  the  Federal  dollar  would  be  well  spent,  coming  up  with  a 
deto-^ifi^ntion  nnd  ab'-tinence  notential  in  another  drnier. 

T  think  the  chairman  mentioned  before  the  possibility  of  coming  up 
with  a  drug  that  would  make  it  revolting  to  have  one  narcotic. 

With  the  American  pharmaceutical  mind  we  ought  to  be  able  to 
come  up  with  something  like  that. 

Chairman  Pept^er.  We  have  discovered  from  onr  A^arious  hearings 
that  about  half  of  the  crime  is  related  to  drug  use,  and,  therefore,  if 
we  could  cnt  down  drug  use  we  would  reduce  crime. 

That  is  the  reason  the  House  of  Pepresentatives  is  concei^ned  about 
drugs.  So  we  are  dealing  with  something  directly  related  to  crime,  are 
we  not  ?  T  ask  you  as  a  prosecuting  attorney. 

Mr.  HoRAN^.  There  is  no  question  about  that. 

Chairman  Pepper.  Thank  you  very  much. 


273 

Any  other  questions,  gentlemen  ? 

Thank  you,  Mr.  Horan.  We  appreciate  your  coming  here  today. 

The  committee's  next  witness  is  Dr.  Daniel  H.  Casriel,  a  New  York 
psychiatrist  who  has  long  been  interested  in  drug  addict  rehabilitation 
programs. 

Dr.  Casriel  received  his  medical  training  at  the  University  of  Cin- 
cinnati, and  served  as  a  captain  in  the  U.S.  Army  Medical  Corps. 

Dr.  Casriel  has  served  as  court  psychiatrist  in  the  New  York  City 
Court  of  Special  Sessions;  psychiatric  consultant  to  the  S^'nanon 
Foundation ;  clinical  assistant  professor  of  psychiatry  at  Temple  Uni- 
versity Medical  School,  and  cofounder  and  medical-psychiatric  direc- 
tor of  Daytop  Village,  a  therapeutic  community  for  addicts. 

Dr.  Casriel,  in  addition  to  the  private  practice  of  psychiatry,  is  the 
director  of  AKEBA,  an  addict  treatment  program  in  New  York. 

He  is  the  author  of  "So  Fair  A  House,"  the  story  of  Synanon,  as 
well  as  the  author  of  several  articles. 

Out  of  your  wide  experience.  Doctor,  we  are  very  much  pleased  to 
have  you  here  today.  I  am  advised  that  you  are  accompanied  by  Dr. 
Walter  Rosen  and  Rev.  Raymond  Massy,  who  will  supplement  your 
statement  and  respond  to  questions. 

Mr.  Perito,  would  you  inquire  ? 

Mr.  Perito.  Thank  you,  Mr.  Chairman. 

Dr.  Casriel,  as  you  have  been  kind  enough  to  provide  us  with  some 
written  material  and  a  statement  by  Dr.  Revici ;  is  that  correct  ? 

STATEMENT  OF  DE.  DANIEL  H.  CASEIEL,  DIEECTOE,  ACCELEEATED 
EEEDUCATION  OF  EMOTIONS.  BEHAVIOE,  AND  ATTITUDES 
( AEEBA) ;  ACCOMPANIED  BY  EEV.  EAYMOND  MASSE Y.  INSTITUTE 
OF  APPLIED  BIOLOGY,  INC. ;  AND  DE.  WALTEE  EOSEN 

Dr.  Casreel.  Yes;  I  have  given  you  some  of  the  written  material 
and  my  remarks  after  Dr.  Revici's  initial  lecture  on  his  new  drug  called 
Perse.  I  didn't  give  you  the  article  that  Dr.  Revici  has  written,  but  I 
assume  you  have  that. 

Mr.  Perito.  Yes ;  we  do. 

Mr.  Chairman,  at  this  point  I  respectfully  request  that  the  materials 
which  have  been  furnished  to  us  by  Dr.  Casriel  be  incorporated  into 
the  record. 

Chairman  Pepper.  Without  objection,  they  will  be  received  and  will 
appear  following  Dr.  Casriel's  testimony. 

Mr.  Perito.  Dr.  Casriel,  you  have  worked  with  the  addiction  prob- 
lem in  a  substantial  portion  of  your  professional  life;  is  that  correct? 

Dr.  Casriel.  That  is  correct.  Almost  20  years. 

Mr.  Perito.  Is  it  fair  to  say  that  your  therapeutic  approach  is  an 
amalgamation  of  your  learning  from  Synanon  and  Daytop,  plus 
some  innovative  thinking  of  your  own  ? 

Dr.  Casriel.  Also  my  training  in  Columbia  Psychoanalytic  Insti- 
tute, my  experience  in  Synanon,  my  establishment  of  Daytop,  my  ex- 
perience in  Daytop  and  my  own  private  practice. 

I  have  a  new  amalgam  of  treatment  now  which  is  different  from  all 
of  these  and  I  find  it  clinically  very  effective. 


274 

;Mr.  Perito.  It  is  my  understanding,  Doctor,  that  in  your  treat- 
ment ajiproach  you  have  been  using-  a  new  experimental  drug;  is  that 
correct  ? 

Dr.  Casrtel.  Yes ;  it  is,  Mr.  Perito. 

Mr.  Perito.  And  that  experimental  drug  can  be  properly  referred 
to  as  a  rapid-acting  detoxification  drug? 

Dr.  Casriel.  Yes ;  it  can. 

Mr.  Perito.  That  drug  is  nonaddictive  ? 

Dr.  Casriel.  It  is  nonaddictive. 

Mr.  Perito.  Could  you  kindly  explain  to  the  chairman  and  members 
of  this  committee  what  your  experience  has  been  with  the  use  of  this 
drug  ? 

Dr.  Casriel.  Yes. 

Chairman  Pepper.  You  are  talking  about  the  drug  Perse,  P-e-r-s-e? 

Dr.  Casriel.  Right. 

I  met  Dr.  Revici,  the  developer  of  this  drug,  a  year  ago  last  Febru- 
ary, and  I  guess  like  most  of  you  who  might  have  seen  it  for  the  first 
time,  I  didn't  believe  my  clinical  eyes,  but  in  the  past  14  months  I  am 
convinced  that  this  is  a  major  breakthrough,  on  a  chemical  basis,  of 
the  addictive  phenomena  of  addiction. 

I  personally  have  given  it  to  about  a  100  addicts,  about  30  of 
whom  have  remained  in  my  therapeutic  community,  called  AREBA, 
which  stands  for  the  Accelerated  Reeducation  of  Emotions,  Be- 
havior, and  Attitude. 

I  have  never  found  any  hai'mful  side  effects  from  Perse  per  se.  It 
has  removed  not  only  the  addicting  quality,  but  it  gives  the  individual 
a  sense  of  well-being,  the  type  of  well-being  he  had  before  he  was 
addicted. 

However,  I  would  like  to  make  sure  that  the  committee  realizes 
there  is  a  difference  between  an  addict  who  is  addicted,  and  an  addict 
who  is  not  addicted. 

After  you  remove  the  addiction  you  still  have  to  treat  the  individual. 

My  work  in  the  past  20  years  has  been  with  people.  I  have  rehabil- 
itated tlie  addicted  and  it  really  doesn't  make  mucli  difference  what 
they  are  addicted  to,  whether  it  is  heroin,  or  morphine,  or  alcohol,  or 
homosexuality,  or  delinquency,  or  whatever. 

The  basic  underlying  personality  structure  has  to  be  changed. 

Perse  has  made  my  job  much  easier  with  those  character  disorders 
called  the  addict. 

Chairman  Pepper.  With  what? 

Dr.  C ASPJEL.  With  those  people,  the  psychiatrists  call  the  addicted 
personality. 

Chairman  Pepper.  I  see. 

Mr.  Pfrito.  Doctor,  is  it  fair  to  sav  that  you  are  drawinij  a  distinc- 
tion  between  physical  addiction  and  ps3^chic  addiction  ? 

Dr.  Casrtel.  Yes ;  there  is  a  tremendous  distinction.  Perse  removes 
the  physical  addiction,  the  phA'siological  addiction.  It  takes  the  type  of 
psychotherapy  that  I  am  doing,  whicli  is  much  different  than  classical 
psychotherapy,  to  restructure  the  addict. 

'■I  think  in  terms  of  the  physiological  addiction,  the  physical  ad- 
diction, it  is  interesting  that  the  several  people  I  heard  before  me 


Avho  spoke  about  methadone  and  methadone  blockade  really  have  not 
mentioned  what  do  they  mean  by  blockade,  where  does  the  location  of 
the  blockading  effect,  what  is  the  j^hysiological  cause  of  addiction, 
how  does  addiction  work,  what  is  addiction,  how  does  it  Vvork,  v\'hy 
does  m.ethadone  blockade,  what  does  it  blockade,  et  cetera,  et  cetera,  et 
cetera. 

These  answers  have  never  been  mentioned.  I  am  aghast,  really,  that 
this  whole  concept  of  methadone  maintenance  started  with  the  re- 
search, clinical  research  of  six  highly  addicted  heroin  addicts  by  Dr. 
Dole,  who  then  transferred  them  to  methadone  and  maintained  them 
on  methadone. 

Tliere  is  no  theory,  no  pharmacological  theory  to  substantiate  meth- 
adone addiction  or  methadone  maintenance. 

I  met  Dr.  Eevici.  He  is  a  fine  old  gentleman.  He  speaks  in  such  a 
quiet  voice  and  he  is  so  esoteric  it  took  me  about  a  year  to  really  un- 
derstand his  understanding  of  the  nature  of  addiction,  and  if  I  may, 
in  the  next  few  minutes,  I  would  like  to  give  this  committee  my  inter- 
pretation of  his  understanding  of  the  nature  of  addiction. 

He  developed  Perse  with  a  pencil  and  paper.  He  theorized  the 
nature  of  addiction  from  his  knowledge  of  intercellular  physiology, 
biochemistry,  and  pharmacology.  With  this  theoretical  approach  he 
then  theorized  the  type  of  pharmacological  type  of  drug  that  was 
needed  to  solve  it. 

Chairman  Pepper.  That  is  the  way  Dr.  Einstein  developed  the 
Einstein  tlieory,  with  a  pencil  and  paper. 

Dr.  Casriel.  On  a  piece  of  paper,  a  pencil  and  piece  of  paper,  and 
you  might  have  said  he  never  had  enough  money  to  do  it  any  other 
way. 

He  took  this  chemical  and  applied  it  successfully  to  thousands  of 
laboratory  animals  and  then  finally  applied  it  to  several  thousand 
patients  that  he  has  detoxicized  from  heroin  without  any  harmful 
effects. 

I  have  detoxicized  about  100  without  any  harmful  effects  whatso- 
ever. I  have  personally  taken  some  Perse,  myself,  to  see  the  effect  that 
it  would  have  in  preventing — it  also  prevents  alcohol  addiction,  alco- 
hol intoxication — to  see  what  it  would  do  to  me  in  preventing  alcoholic 
intoxication.  Normally  2  ounces  of  alcohol  taken  by  me  will  give  me  a 
drunk  and  I  fall  asleep.  One  big  cocktail  will  get  me  sleepy  on  an 
empty  stomach. 

I  took  two  of  his  capsules  of  Perse  and  proceeded  to  drink  8  ounces 
of  scotch  without  any  side  effects  of  dysarthria  or  intoxication.  It  is 
true  my  belly  felt  a  little  bloated  and  my  wife  told  me  I  smelled  like 
a  kangaroo,  but  I  was  not  drunk.  I  had  no  harmful  effects. 

I  have  no  hesitation,  if  necessary,  to  inject  this  whole  bottle  of  Perse 
into  me.  I  am  that  sure  of  its  safety. 

This  is_a  100  cubic  centimeter  bottle.  The  addict  only  takes  5-10 
cubic  centimeters. 

("hairman  Pepper.  Orally? 

Dr.  Casriel.  Injectable,  because  we  know  how  much  is  going  in  that 
way.  The  first  day  about  four  times,  the  second  about  three  times,  the 
third  day  twice  and  the_  fourth  day  one  injection,  and  this  is  supple- 
mented with  the  pills  which  are  continued  for  the  week. 


276 

So  that  at  the  end  of  the  week  this  person  is  detoxicized  from  his 
addiction. 

Chairman  Pepped.  You  mean  if  anybody  had  been  taking  heroin  for 
a  protracted  period  of  time  and  had  that  course  of  injections  which 
you  just  described,  all  in  1  week,  that  at  the  end  of  that  week  that 
person  would  not  have  any  further  craving  for  heroin  ? 

Dr.  Casriel.  Wliile  he  is  on  Perse,  no  further  physiological  craving, 
but  if  he  stops  taking  Perse  and  takes  heroin,  he  will  get  his  old  habit 
back,  his  old  euphoria. 

The  first  injection  of  Perse  immediately  cuts  down  the  amount  of 
heroin  they  need  to  sustain  their  addiction.  I  have  seen  people  go  from 
iiO  bags  a  day  to  one  bag  until  they  came  to  me  the  next  clay  and  got 
another  shot  of  Perse. 

Now,  how  does  Perse  work?  Dr.  Revici  stated  that  heroin  is  an 
alkaloid.  iVn  alkaloid  is  a  building  block  of  protein.  Those  chemicals 
which  are  addictive  are  basically  alkaloids  building  blocks  of  proteins. 
Now,  if  you  put  a  specific  protein  into  your  body  like  milk,  you  will 
get  a  specific  reaction  to  that  milk,  you  will  get  a  marked  inflammed 
area  and  you  will  develop  certain  antibodies  to  counteract  the  proteins 
in  the  milk. 

But  an  alkaloid  is  only  a  small  portion  of  a  protein  and  it  doesn't 
develop  a  specific  antibody  when  it  is  injected.  Instead,  the  body  devel- 
lops  a  generalized  defensive  substance  which  is  a  steroid,  which  com- 
bines with  the  alkaloid,  be  it  heroin,  or  methadone,  or  morphine.  But 
because  it  is  not  specific  there  is  an  overproduction  of  this  steroid. 

For  instance,  if  one  unit  of  heroin  got  into  the  body,  the  body  miglit 
manufacture  in  an  analogous  two  units  of  steroids,  one  which  combines 
with  the  heroin  and  neutralizes  the  effect  of  the  heroin. 

The  other  one  is  free  in  the  body.  It  is  this  free  steroid  which  is  not 
attached  to  the  heroin  which  causes  the  addictive  phenomena,  it  causes 
the  craving  phenomenon. 

Now,  when  a  person  who  has  never  used  a  narcotic  injects  a  small 
portion  of  narcotics  into  his  body  or  takes  it  orally,  the  body's  defense 
system  is  activated.  The  injectable  route  is  the  quickest  route.  If  you 
digest  it,  it  take  a  little  longer  to  get  into  the  bloodstream.  The  eftects 
of  the  narcotics  will  be  felt  by  the  body,  it  goes  to  the  brain  centers. 
It  diminished  the  body's  awareness  of  pain  and  it  is  a  basic  depressant. 
One  dies  of  an  overdose  because  one's  respiration  stops  and  then  the 
individual  stops  breathing.  That  is  how  one  dies  of  an  overdose. 

One  of  the  lifesaving  measures  is  to  give  artificial  respiration  imtil 
the  effect  of  the  narcotic  is  passed  out  of  the  body. 

Now,  the  body  removes  heroin  in  about  4  to  6  hours.  It  takes  the  body 
about  36  hours  to  remove  methadone.  That  is  why  one  injection  or 
one  pill  of  methadone  can  last  at  least  24  hours,  Avhereas  one  injection 
or  one  pill  of  heroin  would  only  last  4  to  6  hours. 

But  when  this  heroin  is  detoxicized  it  is  removed  by  the  body,  the 
steroid  whicli  the  body  has  developed  previously  to  defend  itself 
against  the  hei-oin  is  free  and  it  gradually  develops  an  attraction  to  the 
body  tissue,  sotting  up  a  type  of  ])ulling  or  craving  sensation.  It  sets  up 
in  tile  body  what  Dr.  Eevici  calls  an  anoxicbiosis,  which  when  ti-ans- 
lated  into  English  means  a  negative  oxygen  metabolism.  It  is  ver}' 
similar  to  the  type  of  pain  and  feelings  you  would  get  if  a  tourniquet 


277 

were  tied  around  your  hand.  You  get  a  negative  oxygen  metabolism 
Avith  an  increase  of  lactic  acid.  The  oxygen  isn't  present  to  break  down 
the  carbohydrates  in  the  body. 

"Wliat  we  have  then,  after  the  injection  of  heroin  after  4  hours,  the 
heroin  goes  through  the  body,  we  have  this  steroid  which  turns  upon 
the  body  which  produced  it,  causing  an  anoxicbiosis.  This  is  perceived 
by  the  addict  as  a  craving,  as  a  yearning.  As  this  anoxicbiosis  builds 
up  greatei-  and  greater,  depending  on  the  amount  of  steroids,  there  is 
localized  acidosis  that  develops  in  the  body  and  the  body  attempts  to 
compensate  for  this  localized  acidosis  by  a  generalized  alkaline  reac- 
tion. This  is  manifest  clinically  as  the  so-called  cold  turkey  phenom- 
enon. It  is  very  uncomfortable  for  the  addict  to  experience.  It  is  seen 
with  high  amounts  of  steroid — not  high  amounts  of  heroin — but  a 
high  amount  of  steroid  developed  over  a  long  period  of  addiction  or 
due  to  methadone  maintenance.  The  blockading  effect  of  methadone, 
by  the  way,  is  just  the  overwhelming  of  the  body's  ability  to  produce 
more  steroids  and  the  body  then  develops  a  tolerance  for  methadone, 
just  as  some  people  who  start  to  become  heavy  alcoholic  drinkers  can 
show  heavy  tolerance  for  alcohol  before  they  become  drunk.  I  have 
seen  people  drink  10  ounces  of  alcohol  and  look  like  they  are  sober. 

But  tlie  steroid  which  has  been  produced  in  response  to  this  foreign 
alkaloid,  remains  in  the  body  about  7  days.  It  takes  about  7  days  for 
this  steroid  to  break  down.  This  is  why  it  takes  7  days  to  detoxify  some- 
body from  addiction.  It  takes  7  days  to  maintain  a  state  of  oxygena- 
tion in  the  body  while  the  steroid  is  being  broken  down. 

Dr.  Revici  has  developed  other  pharmacological  tools  to  go  along 
with  this  basic  tool  called  Perse.  For  instance,  when  a  person  has  been 
on  methadone  maintenance,  for  instance,  he  has  so  much  steroid  in  him 
that  all  the  Perse  that  you  give  him  still  causes  some  side  effects,  you 
just  can't  get  enough  of  this  oxygenizing  substance  into  the  tissue  and 
that  is  all  that  Perse  is. 

Mr.  Perito.  Doctor,  excuse  me. 

Are  you  saying  it  is  more  difficult  to  detoxify  a  methadone  addict 
than  a  heroin  addict  ? 

Dr.  Casriel.  Yes,  because  a  person  on  methadone  maintenance,  has 
tremendous  quantities  of  defensive  substance  built  up  in  them.  Dr. 
Revici  has  developed  a  substance  which  will  temporarily  combine  and 
neutralize  the  steroid  in  the  blood  and  this  is  called  trichlorbutinol. 
It  is  an  alcohol,  but  the  interesting  thing  about  this  alcohol,  it  doesn't 
develop  more  steroid. 

For  instance,  if  I  have  given  a  person  who  is  really  under  tremen- 
dous craving,  and  you  know  he  has  a  large  steroid  component  because 
he  has  been  on,  say,  methadone  maintenance,  I  would  give  him,  to- 
gether with  the  Perse,  some  trichlorbutinol.  Within  7  to  15  seconds  he 
feels  better  because  that  alcohol  combines  with  the  steroids  in  the 
bloodstream.  It  takes  about  7  to  15  minutes  for  the  Perse  to  get  into 
the  tissue  to  counteract  the  anoxiobiosis.  If  the  person  is  already  in 
secondary  stages  of  withdrawal,  the  cold  turkey  phenomenon,  you  can 
give  him  a  little  hydrochloric  acid  to  counteract  the  generalized  alka- 
line condition  that  he  has. 

If  we  know  the  degree  of  his  steroid  developed,  we  can